FAMILY PLANNING METHODS AMONG COUPLES OF A SELECTED

BARANGAY IN TACLOBAN CITY: BASIS FOR HEALTHCARE

PROGRAM ENHANCEMENT

BY

RIC-AN ARTEMIO S. GADIN

GRADUATE SCHOOL
THE PHILIPPINE WOMEN’S UNIVERSITY
MANILA
2012
FAMILY PLANNING METHODS AMONG COUPLES OF A SELECTED

BARANGAY IN TACLOBAN CITY: BASIS FOR HEALTHCARE

PROGRAM ENHANCEMENT

A Thesis Presented to
the Faculty Committee of the Graduate School of
The Philippine Women’s University
Manila

In Partial Fulfillment
of the Requirements for the Degree
Master of Arts in Nursing

By

RIC-AN ARTEMIO S. GADIN

2012
 ACKNOWLEDGEMENT

This study would not be of success without first and foremost, our

Heavenly Father who gave me the strength to weather through difficult and

trying times; I give him Glory and Honor as I offer this paper unto Him.

This also requires the assistance of experts, colleagues, friends and

participants for which I am so blessed with. To this end, I would like to

acknowledge the different kinds and forms of support of the following:

To Dean Ma. Edna F. Dominguez of the School of Nursing Graduate

Program, for her encouragement to finish my master’s study;

To my advisers, Prof. Greg Mendoza III and Dr. Ciriaco Ty, for their

generosity in spending time and guidance.

To the members of the thesis committee, who shared their respective

knowledge and wisdom to make this study a scholarly piece: Dean Ma. Edna

F. Dominguez, Dr. Ligaya Braganza, Dr Rhodora Escaño, and Prof. Liwayway

Vallesteros.

To Dr. Jovita Pilar, ANSAP adviser and former PWU faculty, for her

wisdom, encouragement and guidance to finish this thesis writing.

To Ms. Ma. Victoria Cagnan, Chief Nurse and MCNAP Leyte Chapter

President, for her patience, encouragement, guidance, and continuous

support in the conduct of this study in the MCNAP adopted barangay;

 To my father, mother and brother, for all the support and

understanding they gave as I ventured in all my undertakings;

To my friends and colleagues who supported and encouraged me

finish this manuscript.

And finally, special acknowledgement is due to a special someone who

served as my inspiration and for the unconditional love.

RASG
 ABSTRACT

FAMILY PLANNING METHODS AMONG COUPLES OF A SELECTED

BARANGAY IN TACLOBAN CITY: BASIS FOR HEALTHCARE

PROGRAM ENHANCEMENT

By

RIC-AN ARTEMIO S. GADIN, MAN

The increase of population affects many aspects of society, including

living conditions, basic needs, employment status and most importantly the

health system. It is thus imperative to adequately plan family size in order to

build a stable society. But despite of the availability of family planning

programs where most methods of contraception are available both in the rural

and urban health centers, literatures shows that population growth is still at

rise. Thus the researcher became curious of the knowledge, attitude and

practices of couples in family planning.

The study tried to assess the level of awareness and practices of

family planning methods among couples in a selected Barangay in Tacloban

City. It tried to seek the demographic profile of the respondents, their level of

awareness and practices on the different family planning methods, and

establish if there is any relationship between their level of awareness and

demographic profile.

This study followed a quantitative research model using an explorative

and descriptive design to assess the level of awareness and practices of

family planning practices among families in a selected barangay. Data were

gathered through personal interview through the use of a survey

questionnaire to all 109 couples within reproductive age of 15 - 49 in the

selected barangay and were analyzed with the use of Pearson – r, Eta

correlation, and T-Test.

Generally, the couples are educated adults earning below the poverty

level income with an average of 3 children majority of whom were practicing

family planning for five years and less.

The more common and easy to practice natural family planning

methods which include abstinence, withdrawal, and standard days method,

the higher is the couple’s awareness level. On the other hand, the easier to

use and readily available artificial family planning methods include bilateral

tubal ligation, use of pills, injectables, and condom is the higher couple’s

level of awareness.

Easy to practice natural family planning methods are the most

observed method in the community to include abstinence and withdrawal. The

more complicated the method become the least likely it will be practiced by

couples. Condoms, pills, bilateral tubal ligation, and injection which are more
accessible and readily available artificial family planning methods in the

community are the most chosen and utilized by the couples.

Age, number of children, and the number of years using family

planning do not affect the couples’ level of awareness but they are rather

affected by religion, educational attainment, occupation, and monthly income.

Religion being a cultural aspect does influence awareness on specific

family planning methods which include ovulation method and IUD use.

Educational attainment influence awareness on highly technical family

planning methods that need deeper understanding which include Coitus

Interuptus / Withdrawal, Calendar/Rhythm/Standard Days Method, Mucous/

Billings/Ovulation Method, Lactating Amenorrhea Method, Birth Control Pills,

IUD and Vasectomy. Occupation influences Mucous/Billings/Ovulation

Method and Birth Control Pills and monthly income influence awareness on

Ovulation Method, Lactating Amenorrhea Method Birth Control Pills,

Condoms, and IUD. Thus, the higher socio-economic status couples have the

more access to the information and somehow interest on these family

planning methods there is.

 TABLE OF CONTENTS

Chapter Page

1 THE PROBLEM AND ITS BACKGROUND

Introduction 1

Background of the Study 3

Research Locale 4

Statement of the Problem 5

Hypothesis 6

Significance of the Study 6

Scope and Limitation of the Study 7

Definition of Terms 8

2 REVIEW OF RELATED LITERATURE AND STUDIES

Family Planning and the Society 10

Family Planning Program 22

Family Planning Methods 28

Natural Family Planning Methods 29

Artificial Family Planning Methods 33

Synthesis 40

Theoretical Framework 41

3 METHODOLOGY

Research Design 45
 Participants of the Study 46

Instrumentation 46

Data Gathering Procedures 47

Statistical Treatment of Data 48

4 PRESENTATION, INTERPRETATION AND ANALYSIS

OF DATA

Demographic Profile of Participants 51

5 SUMMARY, CONCLUSION AND RECOMMENDATIONS

Summary of Findings 75

Conclusions 78

Recommendations 80

Proposed Health Education Program Action Plan to 82

Increase Awareness on Family Planning Methods among
Couples

BIBLIOGRAPHY 86

APPENDICES 97

CURRICULUM VITAE 109

 LIST OF FIGURE

Figure Page

1 Research Paradigm 44
 LIST OF TABLES

Table Page

1 Profile Distribution of Participants 52

2 Level of Awareness among Participants on Family 55

Planning Concepts

3 Level of Awareness among Participants on Family 57

Planning in terms of Natural Method

4 Level of Awareness among Participants on Family 60

Planning in terms of Artificial Method

5 Summary and Ranking of Awareness on Natural and 63

Artificial Family Planning Method

6 Family Planning Practices 64

7 Significant Relationship between Participant’s Level of 67

Awareness on Family Planning and Demographic
Profile
 LIST OF APPENDICES

Appendix Page

A Letter of Request to Conduct Study 97

B Validation Letter 99

C Informed Consent 100

D Survey Questionnaire 101

E Sample Analysis/Computations 106

 Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

Family Planning in simplest term is the couple’s way of preparing their

intended family, by utilizing or using various methods of natural or scientific

birth control measures and techniques.

In the Philippines, the population has nearly doubled in just three

decades to 94 million, making the Philippines the world’s 12 th most populous

nation “At the current rate of 2.04% growth the highest by far in South-east

Asia, 50 million Filipinos in 30 years” (Population Commission 2011). The

increase of population affects many aspects of society, including living

conditions, basic needs, employment status and most importantly the health

system. It is also a predicament of a growing number of poor women in the

Philippines who lack access to one of the most essential forms of health care.

Planning ahead has always been imperative in affecting the outcome

of life-changing situations for everyone, which most certainly applies when it

comes to pregnancy. The Philippine family planning program began in the

1970’s that reflected a concern with the rapid population growth and in

adequate maternal and child health. Over the past decades the program has

had varying degrees of political support and consequently somewhat erratic

implementation. In the past six years there has been an attempt to revive the
 2

training of maternal child health and family planning workers and increase the

choice of contraception (www.fhi.org.).

The implementation of Family Planning in a Barangay would decrease

maternal deaths and casualties of mother giving birth aside from the fact that

child abortion due to unwanted pregnancies will decrease, thus, promote

proper and safer sexual behavior. In addition, it may also help improve their

children’s lives because they can easily secure the educational security of

their children while they are still young. Further, it would drastically slow down

the population outgrowth, which is very crucial to many major environmental

and geological phenomena.

However, Villegas (2011) pointed out that even if population control

can contribute to solving poverty today, there are other more direct solutions

that will not harm future generations of Filipinos. Among them are agricultural

and rural development, nurturing of small and medium-scale enterprises,

authentic agrarian reform backed-up by efficient infrastructures in the

countryside, microcredit and microenterprise development, improving the

quality of basic education for the poor, providing technical skills to the out-of-

school youth, partnering with the private sector in implementing corporate

social responsibility, and many others that your expert advisers can think of.

Through these many corollary benefits, family-planning programs are

essential to achieving development targets. However, in many low-income

countries, women and men do not have access to the basic supplies and
 3

services they need, whether to prevent unwanted pregnancies, ensure safe

deliveries, or manage and treat sexually transmitted infections.

Background of the Study

Family planning allows individuals and couples to anticipate and attain

their desired number of children and the spacing and timing of their births. It is

achieved through the use of contraceptive methods and the treatment of

involuntary infertility. A woman’s ability to space and limit her pregnancies has

a direct impact on her health and well-being as well as on the outcome of

each pregnancy (WHO, 2011).

By virtue of Executive Order 119, the Philippine Family Planning

Program has a legal mandate emanating from the United Nation Declaration

of Human Rights which considers Family Planning as a basic human right,

and the Philippine Constitution recognizes the:

Sanctity of family life and the need to protect the life of the

mother and the unborn from conception (ART. 11, Sec 12).

Family as the foundation of the nation. Accordingly, the state

shall strengthen its solidarity and actively promote its total

development (Art XV, Sec. I)

Right of spouses to find a family in accordance with their

religious convictions and demands of responsible parenthood (Art. XV,

Sec 3.1)
 4

Right of the family association to participate in the planning and

implementation of policies and programs that affect them, (Art. XV,

Sec. 3.4).

The goal of the program is to provide the people universal access to

Family Planning information, education and services whenever and wherever

these are needed.

Despite of the program where contraception is available both in the rural

and urban health centers for free, 1.7 million babies are born annually in the

Philippines, representing a population growth rate of 2.04 percent, among the

highest in Asia (Manila Bulletin, 2011). The researcher himself is a nurse

educator who has been exposed in the maternal health services and

responsible for helping a client make an informed, voluntary and well

considered decision about fertility and safe family planning. Thus the

researcher became curious of the knowledge, attitude and practices of

couples in family planning.

Research Locale

The study was conducted at Barangay 56 - A, Tacloban City, classified

as a highly urbanized city in Region VIII. The selected Barangay is an

adopted Barangay of the Mother and Child Nurses Association of the

Philippines, Inc. (MCNAP) Leyte Chapter. Being a member of the

organization, it motivates the researcher to conduct the study which is geared

 5

towards attaining its cause to Maternal and Child Nursing improvement

through continuous provision of safety quality care, education and training,

and research and management.

Barangay 56 - A is a populated community with a total population size

of 667, located at the heart of Tacloban City. It is estimated that there are

about 128 households with a number of children ranging from 1 - 10. Having

extended families is also noted as a typical practice in the area, thus every

household may contain a couple of families. Even at the heart of the city,

economic status of the said community is depressed. Eighty percent (80%) of

the population have fishing as their major source of livelihood and the

remaining twenty percent (20%) are pedicab drivers, laborers, or employees

(MCNAP Annual Data Report, 2010).

Statement of the Problem

The study tried to assess the level of awareness and practices of

family planning methods among couples in a selected Barangay in Tacloban

City. Specifically, this study sought answers to the following questions:

1. What is the demographic profile of the participants in terms of:

1.1 Age,

1.2 Religion,

1.3 Educational Attainment,

1.4 Occupation,
 6

1.5 Monthly income,

1.6 No. of children, and

1.7 No. of years using family planning?

2. What is the level of awareness of the participants on family planning in

terms of:

2.1. Natural method and

2.2. Artificial method?

3. What Family Planning methods are commonly practiced by the

couples?

4. Is there a significant relationship between the participant’s level of

awareness and demographic profile?

5. Based from the results of the study, what strategies can be made to

enhance the family planning program.

Hypothesis

There is no significant relationship between the participant’s level of

awareness and demographic profile of couples in the selected Barangays.

Significance of the Study

Results from this study would specifically benefit the following:

Partner Communities - as the results of the study will allow them to

have an awareness on the family planning methods being practiced in the

 7

community and get factual information upon which a cogent local policy could

be shaped.

Academe - to help further clarify the different concepts and health care

service provision of the family planning program at the local level.

Parents - particularly in exercising their role as responsible member of

the society. This study elucidates or suggests to them to actively participate in

the minimization of poverty by having family sizes fairly within their means.

Children - as they are the indirect beneficiaries of this study, their

parents realizing the importance of practicing family planning, they in turn will

receive the expected care and economic benefits from their parents.

Health Practitioners - as they will gain insight to effectively exercise

their roles and responsibilities in educating couples or those who are planning

to marry and who want to be more familiar with the family planning practices

and methods.

Future Researchers - as it will also serve as basis for the

development and improvement of the existing family planning program that is

being implemented in the locality.

Scope and Limitation of the Study

This study deals mainly on assessing the family planning methods

practiced by couples of a selected barangay in Tacloban City. The study was

limited to the adopted Barangay of the Mother and Child Nurses Association
 8

of the Philippines, Inc. (MCNAP) Leyte Chapter, Barangay 56 – A, Tacloban

City. Participants were limited to the couples of reproductive age that is from

15 – 49 years old. The study was conducted in June 2012 and was focused

accordingly to the level of awareness of the different common methods of

family planning promoted by the Department of Health. It also highlighted the

preferences on the utilization of the methods offered by the Department of

health.

Definition of Terms

Based on the study, the following terms are operationally defined:

Adoption refers to the positive response of the mothers to the family

planning program thru utilization of the said family planning methods in the

barangay

Awareness pertains to knowledge of the participants regarding the

family planning methods from observation, formal, and informal teachings

Contraceptive is a device that prevents pregnancy, these include

condom, pills intrauterine device, natural family planning, injectable, lactation

amenorrhea method and tubal ligation.

Family Planning is the participant’s way of achieving family welfare by

regulating and spacing of childbirth.

 9

Family Planning Methods, Artificial (AFP) are methods or

techniques by which a couple in the specified barangay can achieve or avoid

pregnancy with the use of drugs, devices, or other synthetic means.

Family Planning Methods, Natural (NFP) are methods or techniques

by which a couple can achieve or avoid pregnancy without the use of drugs or

devices.

Reproductive Age refers to the age cluster of participants who are

capable of bearing children.

 10

Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter presents the view of empirical literature and research

literature derived from various sources such as books, journals and other

published and unpublished materials. These related studies presented were

selected on the basis of their significance in prompting directions for this

current research. The theoretical framework will be the basis of the conduct of

the study.

Family Planning and the Society

The Philippines, officially known as the Republic of the Philippines, is a

country in Southeast Asia in the Western Pacific Ocean. With an estimated

population of about 94 million people, the Philippines is the world's 12th most

populous country. Philippine culture is a combination of Eastern and Western

cultures. The Philippines exhibits aspects found in other Asian countries with

a Malay heritage, yet its culture also displays a significant amount

of Spanish and American influences (Baringer, 2006). More than 90% of the

population are Christians: about 80% belong to the Roman Catholic Church

while 10% belong to other Christian denominations, such as the Iglesia ni

Cristo, the Philippine Independent Church, the Seventh-day Adventist

Church, United Church of Christ in the Philippines, and Jehovah's Witnesses.

 11

The Philippines is one of two predominantly Roman Catholic countries in Asia

(NSO, 2008).

Knowledge of family planning is universal among women in the

Philippines. Use of family planning has increased substantially from the 1970s

to the 1990s but has increased only slowly since 1998. The most commonly

known methods are the pill, male condom, female sterilization, and

injectables. More than half of married Filipino women are using family

planning. One-third (34%) of married women currently use a modern method

of family planning; an additional 17% are using a traditional method. The pill

(16%), withdrawal (10%), and female sterilization (9%) are the most

commonly used methods. Use of modern family planning is fairly consistent in

urban and rural areas but varies by region. In ARMM, only 10% of married

women use a modern method, while in Cagayan Valley, 46% of women are

using a modern method. Modern contraceptive use increases with women’s

education. Thirty-six percent of married women with high school or college

education use modern methods compared with 9% of women with no

education. Use of modern methods is fairly high, even among women from

the poorest households (26%) (NSO, 2009).

Maximum utilization of family planning methods were seen among

Hindu women, women of age group 30 or more, parity four and more,

educational level up to high school and above and those of higher

socioeconomic class (Sharma, 2012). Source of information is mostly through

 12

friends and relatives. Most of the family planning acceptors belong to nuclear

family. The acceptance of family planning increase with level of literacy.

Maximum number of women who have undergone permanent sterilization

had already 2 children at the time of sterilization. IUD is the most accepted

one among the temporary method. Vasectomy was not at all practiced in the

studied slum area. The newer contraceptives like emergency pills or

injectable hormonal contraceptives were not at all used among study

population. The side effects encountered with both temporary and permanent

methods of family planning are statistically insignificant. Furthermore, the

acceptance of family planning practices is influenced by many socio-cultural

and demographic factors at levels of individual, family and society. Among

these different factors, informed choice is evident in forms of education is

considered to exert most profound effect on family planning acceptance and

fertility.

Culture influences men’s attitudes towards family planning. Dewi

(2009) mentioned that the cultural and religious background of an individual

can have a significant effect on men’s attitudes toward family planning and

reproductive health and their use of fertility controls for conception (Andrews,

et al, 2008). Culture persuades the members of a society to act according to a

tradition that has been in existence for generations. It is believed most

especially by Catholic Christians based from Biblical passages from the Book

of Genesis that, men are sent to the world by God after their fall, to procreate.
 13

As such with regards to artificial family planning, Catholic leaders are least

likely to approve and Pentecostal and Muslim leaders are the most likely to

approve of such practices (Yeatman & Trinitapoli, 2008).

According to Regnerus, half of sexually active teenagers who say that

they seek guidance from God or the scriptures when making tough decisions

report using contraceptives in every sexual contact, but it was also

established that, with good family relationship, delay in the practice of

intercourse within the specified age group regardless of religiosity may be

observed (Utter, 2010).

According to Murkoff & Mazel (2009), little babies do come with a hefty

price tag. Planning for a baby should also mean planning for that baby’s

future security. Shah, et al. (2008) reported that socio – economic is one of

the criteria of determinants of family planning. Awareness level about the

different methods of family planning program, a significant difference was

noted between upper-middle and low-socio economic group which was also

supported by Beekle and McCabe (Guria, M, et al, 2009). In India problems

are more difficult and complicated because of marked socio-economic

diversity. In 2006 Gupta and Sinha reported that the success of any method

depends on the regular use, proper knowledge and to create a scientific

attitude to use such method. The knowledge attitude and practices (KAP)

about family planning is noted to be high in educated family but it is not so in

low-economic family (Guria, M, et al, 2009).

 14

In the study of Caltabiano, M & M. Castiglioni (2008), the average age

at marriage among women married before age 20 increased from 13.7 years

for those born in 1952–1956 to 15.6 years for those born in 1977–1981, while

remaining relatively stable for men married before age 25 (17.3 years for the

1942–1946 birth cohort to 17.7 for the 1972–1976 birth cohort). After

individual and couple characteristics were controlled for, younger age at

interview was associated with greater odds of simultaneous marriage and

cohabitation for both genders (odds ratios, 1.3–1.7).

In terms of marriage and starting of family, a study in North America

indicated that, female university graduates born before the 1960s were less

likely to marry than less-educated women. That is no longer the case in

Canada. In fact, by 2006, there emerged a positive relationship between

having a university education and being married. Indeed, women aged 25 to

49 with a university degree are now more likely to be married and start a

family than less-educated women (Martin & Hou, 2010).

In the study of Martin and Hou (2010), it was noted that common-law

unions have become more popular since 1981. The proportion of people aged

25 to 49 in a common-law union quadrupled in Canada, increasing from 4% in

1981 to 16% in 2006. In most cases, common-law unions appear to mark the

starting point of conjugal life rather than a long-term situation. However,

according to recent studies, in some instances common-law unions have

become an alternative to marriage and in 2006, women with a university

 15

education were less likely to be in a common-law relationship than less-

educated women.

Couples who live together before tying the knot are more likely to get

divorced than those who wait until after the big day. A survey of over 1,000

married men and women in the US found those who moved in with a lover

before engagement or marriage reported significantly lower quality marriages

and a greater potential for splitting up than other couples. About one-in-five of

those who cohabited before getting engaged had since suggested divorce -

compared with only 12 percent of those who only moved in together after

getting engaged and 10 percent who did not cohabit prior to the wedding bells

(The Telegraph, 2009).

There are a number of problems arising from the increased rate of

cohabitation. Couples who live together have less financial stability, less

relationship longevity; receive less community support and struggle with

parenting issues. Forty percent of all children will have lived in at least one

cohabiting relationship at some point in their life. It can also be noted that

partners who cohabit with the intention of marrying share many of the

characteristics of married people including the plan for the specific number of

children. Those who cohabit without the intention of marrying often have short

relationships with few benefits (Berg, 2011).

Apart from individual characteristics, socio-cultural factors may either

encourage or prevent women from fully exercising their choice to use

 16

contraception or to work in family planning programs. These factors include:

prevailing expectations and norms regarding women's roles; family systems

that promote or discourage high fertility and son preference; opportunities for

women's social and economic independence through education, employment,

inheritance, and property laws; and restrictions (e.g., religious or legal) on

access to family planning information and services (Hong & Seltzer, 2011).

Family planning programs have been predominantly directed towards

women perhaps because women bear children and there are more

contraceptives for women than for men. However, it has been found in many

developing countries that the decision to use or not to use contraceptives,

and the choice of a particular contraceptive method, very often depends on

the approval of the husband. Therefore, the family planning program must

involve men (as well as women) to satisfy a couple’s sexual and reproductive

needs. Men should also be involved in encouraging their wives to utilize the

available reproductive health care facilities (Dewi, 2009).

Lack of adequate knowledge in family planning methods and the poor

attitude and practices about negative side of over population in adolescent

girls may result in early pregnancy and sexual disharmony. The awareness

program should be included in formal education system especially in the

school curricula so that adolescent girls can acquire correct knowledge from

reliable and social accepted sources rather than from so called magazine,

pornography etc. (Guria, M., et. al, 2009).

 17

Studies on the effect of family programs on fertility decline in low

income countries such as Bangladesh (Joshi and Schultz 2007), Columbia

(Miller 2005), and Peru (Angeles, Guilkey, and Mroz, retrieved 2011) show

only a moderate effect (10-15 percent of fertility decline) can be attributed to

the family planning program.

The role of the woman's education on her fertility has been extensively

discussed in the literature and it's well established that more educated women

tend to have less children (Martin and Juarez; Cleland and Rodriacuteguez)

as cited by Hashem (2009).

Women's use of contraceptives to limit family size or to delay the birth

of the first child may not have an equally positive effect on all their lives. A

woman's individual characteristics -- age, economic situation, marital status,

religion and educational level, as well as the number, sex and age of her

children - affect her decision to use contraception. These characteristics also

affect method choice or the decision to seek work in a family planning

program. If a woman decides to stop childbearing after having six children,

one more child may not make much difference in terms of her future

educational and employment opportunities. By contrast, if a woman delays

her first baby until after she finishes her schooling, this may affect not only her

educational level but also her future employment, since education tends to

have a strong effect on an individual's income level, regardless of

development level (Hong & Seltzer, 2011).

 18

The benefit of involving men in reproductive health activities could also

improve women’s participation in family planning. Studies in Brazil, Indonesia,

and elsewhere have found that there is a growing number of female clients

who have receive their right for using contraception since their husbands

have received family planning information, and attended couples’ counseling

about sexuality (Dewi, 2009)

It is usually maintained that education not only provides opportunities

for personal advancement and awareness of social mobility but it also

provides a new outlook, freedom from tradition, the willingness to analyze

institutions, values and patterns of behavior and the growth of rationalism

(Shukla, 2006). In other words, education is the most dynamic and influential

tool for inducing positive attitude among couples towards the methods and

measures of family planning.

Dewi cited in 2009 that, a study in Ghana covering the period 1988 to

1998 reveals that the level of men’s education influences spousal fertility

references. A husband’s level of educational attainment especially beyond

primary level influences his wife to limit childbearing. Men’s preferences for

smaller families can lead women to desire fewer children. This means less

responsibility and more spare time for women to be involved int social

activities. A smaller family will allow women to raise their status through

attaining higher education or by joining the labor force. On the other hand,

women’s education alone is unlikely to change spousal fertility preferences.

 19

Based on the result of the study conducted by Baul (2008), health

education is an effective way of increasing the Knowledge and Attitude

regarding family planning among the Subanon tribe. Any cultural beliefs and

practices they have did not serve as a hindrance for them to learn family

planning information and to retain them throughout the study period. The

positive result for most of the categories on the questionnaire signifies that

health education is a useful tool in conveying information regarding family

planning among the Subanon women.

The ability to control fertility successfully, likewise requires

understanding of the menstrual cycle and the times and conditions under

which pregnancy is more or less likely to occur – in essence, an

understanding of bodily functions is required (Andrews, et al, 2008).

The reasons and related issues that emerged from the secondary data

analysis for use of family planning includes: (1) Women want to prevent or

delay pregnancy. Because most women (84%) want 2-4 children, with

younger ones wanting three or fewer although the ideal number is moving

towards two as this is easy to support. (2) They want to help their husbands

and immediate families. Women’s priorities are children (first) and husbands

(second); their health is last priority. Having fewer children lets them work to

supplement the family income. (3) They desire to feel better about

themselves. Practicing FP helps women to control their own lives, stay well-

rested, and engage in self-indulgence and entertainment. (4) They wish to

 20

improve their relationship with their husbands. Unrestricted by fear of

pregnancy; couples experience a richer sex life and better communication.

Husbands’ willing participation through encouragement and support of their

wives’ FP practice is necessary. (5) Because they can find a suitable FP

method. a.) Women search for sure, safe and easy to adopt methods b.) Safe

methods are those most certain to prevent pregnancy; safe methods are “risk-

free” in terms of side effects (natural fit) to their bodies. c.) “Easy to adopt”

methods are those that do not require remembering or a lot of poking/looking

into private parts. d.) Women have to weigh their fear of the scary side effects

of pills, IUD and sterilization, with their fear of the ineffectiveness of

withdrawal, condoms, and rhythm. e.) In the national survey, the most

mentioned reason for using contraceptive was because it was safe (42%); the

least mentioned was because religion approved of it (1%). f.) The survey also

found that the greater number of modern methods women could

spontaneously recall, the greater the likelihood they used these methods. So

women were more likely to find a suitable method if they were familiar with a

greater number of methods. For the reason that people encourage them to

practice FP (Kinkaid, 2006), a.) Women tend to use a method that other

women whom they know use. b.) The survey showed that women who talked

about FP to their spouses/partners, and to other women, and who got their

partners’ encouragement, were much more likely to use/continue to use a

 21

modern contraceptive. The strongest relationship was found for

encouragement by one’s spouse/partner (Kinkaid, 2006).

Family Planning Program

Family Planning is considered as a basic human right. Every Individual

has a right to information about family planning; all persons have the right to

decide freely whether or not to practice family planning.

The current emphasis on reproductive health (RH) in population

programs began years ago when human rights and women's health

advocates began to question the rationale of traditional policies that mainly

focused on reducing population growth through the provision of family

planning services (Hardee, 2011).

The consensus definition of reproductive health ratified at the 1994

ICPD represents an important initial step in the process of health service

transformation. Reproductive health is defined as a state of complete

physical, mental and social well-being and not merely the absence of disease

or infirmity, in all matters relating to the reproductive system and to its

functions and processes. Reproductive health therefore implies that people

are able to have a satisfying and safe sex life and that they have the

capability to reproduce and the freedom to decide if, when and how often to

do so. Implicit in this last condition are the rights of men and women to be

informed and to have access to safe, effective, affordable and acceptable

methods of family planning of their choice, as well as other methods of their

 22

choice for regulation of fertility which are not against the law, and the right of

access to appropriate health care services that will enable women to go

safely through pregnancy and childbirth and provide couples with the best

chance of having a healthy infant (Hardee, 2011).

According to the World Health Organization, family planning allows

individuals and couples to anticipate and attain their desired number of

children and the spacing and timing of their births. It is achieved through use

of contraceptive methods, sexuality education, prevention and management

of sexually transmitted infections, pre-conception counseling, and treatment

of involuntary infertility (WHO, 2011).

Family planning programs vary in their characteristics and elements.

Consequently, programs may differ in the ways they influence contraceptive

use, employment opportunities, and other aspects of women's lives. These

variations must be taken into account in any explanatory model of the effect

of family planning on women's lives (Hong & Seltzer, 2011).

According to the Senate Policy Brief titled Promoting Reproductive

Health (2009), the history of reproductive health in the Philippines dates back

to 1967 when leaders of 12 countries including the Philippines' Ferdinand

Marcos signed the Declaration on Population. The Philippines agreed that the

population problem be considered and inadequate maternal and child health

(MCH) as the principal element for long-term economic development. Thus,

 23

the Population Commission was created to push for a lower family size norm

and provide information and services to lower fertility rates.

Over the past two decades, the program has had varying degrees of

political support and, consequently, somewhat erratic implementation. It

focuses to improve and maintain the health of mothers and children by

providing universal access to family planning information and services

wherever and whenever these are needed (Cuevas, 2007).

Information that can contribute to saving lives includes (1) Proper

spacing of pregnancies (at least 2 years apart); (2) Proper timing of

pregnancies (within 20-35 years old); (3) Fewer pregnancies (not more than 4

children), are all aimed to contribute in the reduction of neonatal, infant,

under-five, and maternal deaths . The Targets for the PFPP are the Married

couples of the Reproductive Age (MACRA) group (15-49 years old): (1) those

who have had pregnancies for the past 15 months, (2) those below 20 years

and above 35 years old, (3) those who have more than 4 children, (4) Those

with medical complications that do not necessitate pregnancy (DOH, 2006).

The design, management, and implementation of the program abide with the

following principles termed as the four pillars of the Family Planning program:

responsible parenthood, respect for life, birth spacing and informed choice

(DOH, 2006).

There are two bills aiming to guarantee universal access to methods

and information on birth control and maternal care. House Bill No. 4244 or An
 24

Act Providing for a Comprehensive Policy on Responsible Parenthood,

Reproductive Health, and Population and Development, and For Other

Purposes introduced by Albay 1st district Representative Edcel Lagman,

and Senate Bill No. 2378 or An Act Providing For a National Policy on

Reproductive Health and Population and Development introduced by Senator

Miriam Defensor Santiago. Subsequently, the senate Bill No. 2865 which

substituted SB No. 2378 was prepared Jointly by the Committees on Health

and Demography; Finance; and Youth, Women and Family Relations with

Senators Defensor -Santiago, Lacson and Cayetano as authors.

According to SB 2378 (2011), the State recognizes and guarantees the

human rights of all persons including their right to equality and non-

discrimination of these rights, the right to sustainable human development,

the right to health which includes reproductive health, the right to education

and information, and the right to choose and make decisions for themselves

in accordance with their religious convictions, ethics, cultural beliefs, and the

demands of responsible parenthood. The State likewise guarantees universal

access to medically-safe, effective, legal, affordable, and quality reproductive

health care services, methods, devices, supplies and relevant information

and education thereon according to the priority needs of women,

children and other underprivileged sectors.

In Europe, birthrates are even lower. As a consequence, by 2050 the

population of Europe will have fallen to what it was in 1950. Mr. Longman
 25

says this is happening all around the world: Women are having fewer

children. It's happening in Brazil, it's happening in China, India and Japan. It's

even happening in the Middle East. Wherever there is rapid urbanization,

education for women and visions of urban affluence, birthrates are falling

(Longman, 2004).

Government statistical office has concluded that there is no

overpopulation in the Philippines but only the over-concentration of population

in a number of urban centers. Despite other findings to the contrary, we must

also consider the findings of a significant group of renowned economic

scholars, including economic Nobel laureates, who have found no direct

correlation between population and poverty. In fact, many Filipino scholars

have concluded that population is not the cause of our poverty. The causes of

our poverty are: flawed philosophies of development, misguided economic

policies, greed, corruption, social inequities, lack of access to education, poor

economic and social services, poor infrastructures, etc. World organizations

estimate that in our country more than P400 billion pesos are lost yearly to

corruption. The conclusion is unavoidable: for our country to escape from

poverty, we have to address the real causes of poverty and not population

(CBCP website).

Study conducted by Hashemi (2009) results show that the new family

planning program has significantly reduced the relative risk of higher order

births. The program effect was dramatically strengthened after passing the
 26

new family planning bill in 1993. The effect of program on first birth is not

significant and is marginal which shows that the program has not succeeded

in delaying the first birth. But it clearly played a major role in delaying and

stopping other births especially third birth and higher. Comparing the marginal

effect of different variables of the model on the fertility reveals that woman's

education had much stronger negative effect than the program effect. This

result is consistent with the other similar studies in the literature which

contribute the fertility decline to the development and put less emphasis on

the role of family planning programs.

The attitudes towards contraceptive methods in the designated

communities are mostly neutral or positive, with a slight preference given to

natural methods of contraception. Modern contraceptive methods are rarely

used in the communities because of the fear of side effects and low

availability, especially in the villages without family planning cabinets.

Withdrawal supported by abortion is the most practiced method of regulating

family size in these communities. An overwhelming majority of the study

participants liked the SDM and cited ease of usage, absence of side effects

and lack of cost as its apparent advantages. Both men and women were

eager to learn and use the method. Older members of the community (e.g.,

mothers-in-law who wield considerable influence), were also supportive of the

SDM. The participants suggested individual consultations and group

discussions as equally preferable ways of introducing the method to potential

 27

users. The general opinion was that the method should be taught to women

or a couple. If men are to be included in the training as a separate group, the

methodologies for providing information differ because men preferred printed

materials and male providers (Thompson 2001).

Comprehensive family planning programs have had a much larger

effect for reducing fertility than had the fertility reductions brought about by

substantial improvements in school quality G. Angeles, D. Guilkey, and T.

Mroz (retrieved 2011).

Angeles, Guilkey, and Mroz (retrieved 2011) develop an empirical

model of life cycle fertility that accounts for individual heterogeneity as well as

modeling the endogenous determination of family planning services in

communities in Tanzania. Their empirical modeling approach recognizes that

there might be particular unmeasured features of communities that could be

related to the fertility of women within the community as well as to the

propensity for the government to place family planning programs within the

community. Their results indicate that such selective placement of family

planning programs does have important effects on a researcher’s ability to

measure the programmatic effects. Without controlling for the endogeneity of

the placement of the family planning facilities, they found that hospitals were

the most important type of facility for providing effective family planning

services. After controlling for the endogeneity of the timing of the placement

of the programs, they found that hospitals providing family planning services
 28

had little impact on individual fertility outcomes, while health centers providing

family planning services appeared to have large fertility reducing effects.

Family Planning Methods

Family planning is the use of contraceptives to prevent pregnancy or

observe birth control. Ideally, contraception is the responsibility of both

partners engaging in sex. The practice of contraception may be done by a

variety of methods. Preference is given to the couples unto which method

they may adhere into. Such practices are grouped mainly as that of natural

and artificial family planning method. In natural method, all methods under it

do not utilize any instrument nor give any synthetic materials just to prevent

the occurrence of pregnancy. Artificial method of family planning on the other

hand utilizes synthetic products, equipments, and some hormones in order to

prevent pregnancy.

Until the 1950’s, contraceptive products (products to prevent

pregnancy) were not very reliable or could not be easily purchased. Today, as

many as 40 million women in the United States use some form of

contraception, a figure that represents 60% of women in childbearing age

(CDC, 2009). As such consultation with a health professional may still be

needed to determine the most suitable practice and there should be

discussions between your sexual partners before sex to meet both of your

contraceptive needs. The widespread use of contraceptives today points to

 29

both an increased awareness of responsibility for contraception and the wider

range of options available.

Natural Family Planning Methods

Approximately 124,000 women in the United States use natural

methods of family planning (i.e., cervical mucus or temperature monitoring)

for avoiding pregnancy. Another 434,000 use self-devised calendar formulas

(i.e., rhythm) as a means to avoid pregnancy. Many women rely on natural

markers of fertility to help them achieve pregnancy. The accuracy, ease of

use, acceptability, and effectiveness of natural biological markers to estimate

the time of fertility in the menstrual cycle is important for these women.

Coitus Interruptus / Withdrawal. Coitus interruptus, also known as

the rejected sexual intercourse, withdrawal or pull-out method, is a method of

birth-control in which a man, during intercourse withdraws his penis from a

woman's vagina prior to ejaculation to keep sperm from joining the egg

(STDR, 2011). Withdrawal is sometimes referred to as the contraceptive

method that is “better than nothing”.

Unfortunately, ejaculation may occur before withdrawal is complete

and, despite the care used, some spermatozoa may be deposited in the

vagina. Furthermore, because there may be a few spermatozoa present in

the pre-ejaculation fluid, fertilization may occur even if withdrawal seems

controlled. For these reasons, coitus interruptus is only about 75% effective

(Berek, 2006). Coitus interruptus does not protect against STDs or STIs and
 30

is viewed by medical professionals to be an ineffective method of birth control

and high level of trust and cooperation of couples is required (STDR, 2011).

But, based on the evidence, it might more aptly be referred to as a

method that is almost as effective as the male condom—at least when it

comes to pregnancy prevention. If the male partner withdraws before

ejaculation every time a couple has vaginal intercourse, about 4% of couples

will become pregnant over the course of a year (Jones & et. al, 2009).

However, more realistic estimates of typical use indicate that about

18% of couples will become pregnant in a year using withdrawal. These rates

are only slightly less effective than male condoms, which have perfect- and

typical-use failure rates of 2% and 17%, respectively (Jones & et. al, 2009).

Calendar / Rhythm Method. Calendar Methods are various methods

of estimating a woman's likelihood of fertility, based on a record of the length

of previous menstrual cycles. Various systems are known as the Knaus–

Ogino Method or rhythm method and Standard Days Method. These systems

may be used to achieve pregnancy, by timing unprotected intercourse for

days identified as fertile, or to avoid pregnancy, by restricting unprotected

intercourse to days identified as infertile (Pilliterri, 2010).

Douching. Douching is a method to wash out the vagina, usually with

a mixture of water, vinegar, and antiseptics after sexual intercourse, to

remove seminal fluid. It has been touted as having a number of supposed but

unproven benefits but is equivalently dangerous, as it interferes with both the

 31

vagina's normal self-cleaning and with the natural bacterial culture of the

vagina, and it might spread or introduce infections (Healthwise, 2009). In the

study of Sakru & et. al (2006), vaginal douching tends pregnant women to

genital tract the incidence of vaginal infections, especially those caused by

Enterococcus spp and GBS. As such infections may render such women to

high risk in terms of perinatal mortality and morbidity, thus it is already an

uncommon practice.

Cervical Mucus / Billings Ovulation Method. This is a method

which women use to monitor their fertility, by identifying when they

are fertile and when they are infertile during each menstrual cycle. Attention

to the sensation of the vulva, and the appearance of any vaginal discharge

should be made. This information can be used to achieve or

avoid pregnancy during regular or irregular cycles, breastfeeding, and peri-

menopause. Described by the World Organization of the Ovulation Method

Billings (WOOMB) as "Natural Fertility Regulation", this method may be used

as a form of fertility awareness or natural family planning, as well as a way to

monitor gynecological health (WHO, 2009).

In the study of Fehring (2007), correct - use pregnancy rate was 2.1%

and the imperfect-use pregnancy rate was 14.2% per 12 months of use of

cervical mucus observations which is in fact can be as effective as other

fertility awareness – based methods of natural family planning.

 32

Lactation Amenorrhea Method. This is a method of avoiding

pregnancies which is based on the natural postnatal infertility that occur when

a woman is amenorrheic and fully breastfeeding. LAM is 98% - 99.5%

effective during the first six months postpartum (Alberta Medical Association,

2009). In this method, breastfeeding must be the infant’s only (or almost only)

source of nutrition. Feeding formula, pumping instead of nursing, and feeding

solids all reduce the effectiveness of LAM. The infant must breastfeed at least

every four hours during the day and at least every six hours at night. The

mother must not have had a period after 56 days post-partum (Hatcher,

2007). It was suggested that, suckling stimulus may be the key variable which

determines the return of postpartum ovulation (Howie & McNeilly, 2011).

Basal Body Temperature Method. Basal body temperature is the

lowest temperature attained by the body during rest (usually during sleep). It

can also be utilized to monitor ovulation in females. It is generally measured

immediately after awakening and before any physical activity has been

undertaken, although the temperature measured at that time is somewhat

higher than the true basal body temperature. The higher levels

of estrogen present during the pre-ovulatory (follicular) phase of the

menstrual cycle lower BBTs. The higher levels of progesterone released by

the corpus luteum after ovulation raise BBTs. The rise in temperatures can

most commonly be seen the day after ovulation, but this varies and BBTs can

only be used to estimate ovulation within a three day range. Charting of basal
 33

body temperatures is used in some methods of fertility awareness, and may

be used to determine the onset of post-ovulatory infertility. However, BBTs

only show when ovulation has occurred; they do not predict ovulation. Normal

sperm life is up to five days, making prediction of ovulation several days in

advance necessary for avoiding pregnancy (Berek, 2006).

Over the last 30 years the vast majority of researchers have concluded

that BBT is not a reliable marker of ovulation. According to Guermandi et al

(Fehring & Barron, 2005), reliability in interpretation of temperature curves

ranges from 25% to 50% depending on the day of the cycle being studied

which are affected by many reasons, including the technique of the patient,

confounding factors such as alcohol intake or timing of temperature taking, or

the woman's physiologic hormonal milieu. Despite their use for decades, BBT

charts do not aid in diagnostic decision making about ovulation (Fehring &

Barron, 2005).

Artificial Family Planning Methods

Artificial family planning methods are subdivided into groups as to their

mode of action and or process of practice. In general, there are those

Hormonal Methods, Mechanical / Barrier Methods, and Surgical Methods.

Hormonal Methods

Birth Control Pills. Oral contraceptive pills, commonly known as the

pill or COCs (combination oral contraceptives, are composed of varying

amounts of synthetic estrogen and progestogen hormones. The estrogen acts

 34

to suppress follicle stimulating hormone (FSH) and LH, thereby suppressing

ovulation. The progesterone action complements that of estrogen by causing

a decrease in the permeability of cervical mucus, thereby limiting sperm

motility and access to ova. Progesterone also interferes with tubal transport

and endometrial proliferation to such degrees that the possibility of

implantation is significantly decreased (Pilliterri, 2010).

A variety of pills are available, but essentially they all work in the same

way. Proper intake of pills have 92 – 99% efficacy rate (FPWA, 2009). It is

easy to use as pills are just taken orally every day. Special precautions are

necessary remembering to take it daily, it is not suitable for women who can’t

take estrogen, and that there are certain medication and vomiting or diarrhea

can make the pill less effective(FPWA, 2009).

Indeed there are numerous side effects which unfortunately are not

made known to the general public. For example on top of numerous studies

showing its carcinogenic properties since the development of the synthetic

estrogens in 1938 by Sir Edward Charles Dodds finally the International

Agency for Research on Cancer (IARC) of the World Health Organization

(WHO) announced on July 29, 2005 that after a thorough review of the

published scientific literature, it has concluded that combined estrogen -

progestogen oral contraceptives (and combined estrogen-progestogen

menopausal therapy) are carcinogenic to humans - Group I category. This

 35

category is used when there is sufficient evidence of carcinogenicity in

humans (Miguel-Aguirre, 2008; Nidoy, 2010)

Cancers, Heart Attacks, Strokes, and may cause abortion are just

some of listed major adverse effects of the pill on women. Although the

primary effect of the BCP is (a) to prevent ovulation and (b) to change the

cervical mucus which increases the difficulty of sperm entry into the

uterus, in 1978 (sometime after abortion became legal in the U.S.in

January 1973), a third effect has been listed in drug references and

textbooks of pharmacology that is it causes changes in the lining of the

uterus which makes it hostile to implantation or nidation (Miguel-Aguirre,

2008; Nidoy, 2010).

Further, it was noted that, although the pill is supposed to reach an

effectiveness of over 99%, in practice the rate is much lower. Between 1.9%

and18.1% of women will experience an “unplanned pregnancy” in the first

year of using the pill (therefore contributing to the so-called unwanted

pregnancy), and thus, will most likely end up to abortion (Miguel-Aguirre,

2008).

Injectables. Injectable contraceptives are hormones given thru

parenteral route such as or Depo-Provera (medroxyprogesterone acetate)

norethisterone enanthate (NET-EN), each contain a progestin like the natural

hormone progesterone in a woman’s body. It does not contain estrogen, and

 36

so can be used throughout breastfeeding and by women who cannot use

methods with estrogen (WHO, 2011).

Effectiveness depends on getting injections regularly: This means that

97 of every 100 women using injectables will not become pregnant. Risk of

pregnancy is greatest when a woman misses an injection, thus, fertility

returns after injections are stopped (WHO, 2011).

WHO (2011) reports that users may experience the following on the

First 3 months; Irregular or prolonged bleeding. At one year, there is a

possibility of none / infrequent / irregular monthly bleeding. NET-EN affects

bleeding patterns less than DMPA. NET-EN users have fewer days of

bleeding in the first 6 months and are less likely to have no monthly bleeding

after one year than DMPA users. Weight gain, headaches, dizziness,

abdominal bloating and discomfort, mood changes, and less sex drive may

also be noted.

Mechanical Methods

Condoms and Diaphragms. Condoms and diaphragms are barriers

that prevent the union of sperm and egg cells. Both male and female

condoms may be made latex or polyurethane. For males, it needs to fit

closely over an erect penis. Condoms prevent semen from entering the

vagina. Condoms should only be used with water-based lubricant. For male

condoms, there is 85 – 98% efficacy rate while female condoms have lower at

79-95% only (FPWA, 2009).

 37

Condoms are cheap and easy to buy from pharmacies, supermarkets,

service stations, sexual health clinics and vending machines. It does not

require prescription to secure condoms. No health risks issues as one may

utilize polyurethane condoms if allergic to latex. Further, there is an

involvement of male partners in sharing contraceptive responsibility and gives

protection against most STIs if used correctly (FPWA, 2009).

Condoms and diaphragms are not abortifacient but they have the

highest failure rate varying from 4-30 % depending on the age group

surveyed. It condones promiscuity and since it does not protect 100%, it

contributes to increased incidence of sexually transmitted disease /infection

(Miguel-Aguirre, 2008). Availability of condoms makes people take wilder

sexual risks, thus worsening the spread of the disease as it offers false

reassurance of protection (Nidoy, 2010).

Intrauterine Device. IUDs are inserted into the uterus by a doctor to

prevent sperm from reaching the egg. Its use may give up to 99% efficacy. It

is also easy to use as there is no daily contraception pills to take and worries

for missed doses. It is also cost effective and can last between 5 - 10 years. It

should be noted that this IUDs can change the female menstrual period

patterns and insertion of which should be done by a trained practitioner only

(FPWA, 2009).

The IUD acts primarily by preventing the embryo from implanting and

not by preventing conception. It can be noted that fertilization had been

 38

successful and that, it is the implantation of the fertilized ovum to the uterine

wall that this device prevents. Please note that doctors and scientists in

Embryology, Anatomy and Physiology who study life in its early stages of

development recognize and define life as beginning from fertilization. Thus,

it is therefore an abortifacient, not a contraceptive, as attested to by Dr.

Jerome Lejeune, expert on Fundamental Genetics, University of

Paris. Experts who deny the abortifacient properties of the pill and IUD

have actually transferred the beginning of life from fertilization to

implantation (Miguel-Aguirre, 2008).

Surgical Methods

Bilateral Tubal Ligation. This procedure is also called tubal

sterilization, tubal ligation, voluntary surgical contraception, tubectomy, bi-

tubal ligation, tying the tubes, minilap, and “the operation.” It works because

the fallopian tubes are blocked or cut. Eggs released from the ovaries cannot

move down the tubes, and so they do not meet sperm (WHO, 2011). This is a

permanent contraception for women who will not want more children. There

are two surgical approaches most often used. The first approach is by

minilaparotomy, which involves making a small incision in the abdomen. The

fallopian tubes are brought to the incision to be cut or blocked. The second is

by laparoscopy, which involves inserting a long thin tube with a lens in it into

the abdomen through a small incision. This laparoscope enables the doctor to

see and block or cut the fallopian tubes in the abdomen. It is one of the most
 39

effective methods but carries a small risk of failure: Less than 1 pregnancy

per 100 women over the first year after having the sterilization procedure (5

per 1,000) (WHO, 2011).

Sterilization in the form of ligation and vasectomy is considered a

form of mutilation. Both tubal ligation and vasectomy have its negative

adverse effects. Clients who had tubal ligations may possibly result to high

risk Ectopic pregnancy as the procedure have 1.85% failure rate. Further,

Hemorrhage & bleeding, increased risk of heavy menses in the long term,

Increased future gynecologic rate of surgery including hysterectomy,

diverse anesthesia effects, post tubal ligation syndrome may be

experienced as well (Miguel-Aguirre, 2008).

Vasectomy. This is also called male sterilization and male surgical

contraception. It is a permanent contraception for men who will not want

more children. It is done through a puncture or small incision in the scrotum,

the provider locates each of the 2 tubes that carries sperm to the penis (vas

deferens) and cuts or blocks it by cutting and tying it closed or by applying

heat or electricity (cautery) (WHO, 2011).

It Works by closing off each vas deferens, keeping sperm out of

semen. Semen is ejaculated, but it cannot cause pregnancy. Therefore,

although the man can resume sexual intercourse within 1 week, an additional

birth control method should be used until the two negative sperm reports have

been obtained (Pilliterri, 2010). On the other hand, vasectomy has resulted
 40

to the development of autoimmune response disorders (e.g

thrombophlebitis), prolonged fever, generalized lymph node enlargement,

recurrent infection, skin eruptions, multiple sclerosis, liver dysfunction,

rheumatoid arthritis, risk of prostate cancer, and exacerbates

atherosclerosis (hardening of the arteries). Other adverse effects which

may be noted are; Psychological disorders, Bleeding, infection on the

incision site, Sperm granuloma, Pain in the scrotum, formation of kidney

stones, congestive epididymitis, chronic post vasectomy pain (Miguel-

Aguirre, 2008).

Synthesis

Varied studies stressed and gave importance on the different factors

that affect family planning methods. It had been identified and studies

supported that adoption of these methods varies as different factors came

into consideration. These factors have been generally identified to be as: age,

religion, educational attainment, occupation, socio-economic class, number of

children, and number of years using family planning.

With family planning, it is being emphasized not only as a decision of

the women but a cooperation of both of the couples to elicit a successful

family. Choosing the right contraceptive is an important decision as to avoid

the serious consequence of an unwanted pregnancy. While there is no “ideal

method”, there is a preferred method. Care should be taken into consideration

 41

in choosing a safe method that would avoid unfortunate medical

consequences.

With the current population statistics, there is a need of reinforcing the

Family Planning Programs. The government’s effort to implement such

program should be supported and studied in order to implement a better

program that would enhance the families’ health and well-being without the

compromise of their safety, security, and sense of control of their individual

families, taking into consideration all other aspects of being human.

Theoretical Framework

The study utilized the General Systems Theory of Karl Ludwig von

Bertalanffy and the Behavioral System Model of Dorothy E. Johnson.

Bertalanffy introduced the systems theory as a universal theory that could be

applied to many fields of study (Berman & Snyder, 2011). This theory

provides a way of examining interrelationships and deriving principles. It is

believed that systems may be complex and the systems components are

often studied as subsystems.

According to Berman & Snyder (2011), Bertalanffy believed that a

system depends on the quality and quantity of input, throughput, output, and

feedback. The input is consists of information, material, or energy that enters

the system. It is then processed in a way useful to the system after it is

absorbed, and this transformation is called the throughput. The result of the
 42

process which is also energy, matter, or information is now the output. The

feedback is the mechanism by which some of the output of a system is

returned to the system as input. Feedback enables a system to regulate itself

by redirecting the output of a system back to the system as input, thus

forming a feedback loop which can influence the behavior of the system and

its future output. A negative feedback inhibits change while a positive

feedback stimulates.

According to Tomey & Alligood (2008) Johnson accepted the definition

of behavior as the output of intraorganismic structures and processes as they

are coordinated and articulated by and responsive to changes in sensory

stimulation. She also stated that a system is a whole that functions as a whole

by virtue of the interdependence of its parts and that there is organization,

interaction, interdependency, and integration of the parts and elements.

Johnson’s Behavioral System Model encompasses the patterned,

repetitive, and purposeful ways of behaving. A person as a behavioral system

tries to achieve stability and balance by adjustment and adaptations that are

successful to some degree for efficient functioning (Tomey & Alligood, 2008).

Studies increasingly utilizes System Theories to understand the inter

relationship not only that of the person as a biologic systems but also systems

in families, communities, and nursing and health care.

 43

In applying the above theory to the study, the Input – Process – Output

Model is to be adopted which will provide the general structure and guide for

the direction of the study as presented in Fig. 1.

There are three boxes that are represented. The first box represent the

Input that contains the socio-demographic status of the participants in terms

of (a) Age, (b) Religion, (c) Educational Attainment, (d) Occupation, (e)

Monthly Income, (f) No. of children, and the (g) No of years using family

planning, and level of awareness and adoption of participants on Family

Planning.

The second box represents the Process which are the actions taken

upon utilizing the various inputs through the use of the survey questionnaire

to assess the level of awareness of the participants in relation to the adoption

of family planning practices.

And finally, the third box represents the Output which is the result of

the processes that will help the enhancement and development of the

specified healthcare program. Feedback will then be utilized to determine

effectiveness of the designed program.

 44

INPUT PROCESS OUTPUT

Profile

1. Age
2. Religion
3. Educational Assessment with Proposed
Attainment
4. Occupation the use of Family Planning
5. Monthly Income
6. No. of Children Survey Enhancement
7. Number of
years using Questionnaire Program
Family
Planning

Family Planning
Concepts and
Methods

FEEDBACK

Figure 1

Research Paradigm
 45

Chapter 3

METHODOLOGY

This chapter discusses the research design, participants of the study,

instrumentation, validation, data gathering procedure, and statistical

treatment.

Research Design

This study followed a quantitative research model using an explorative

and descriptive design to assess the level of awareness and practices of

family planning practices among families in a selected barangay. It is

concerned with the collection, classification, and describing characteristics of

which certain phenomena occurs and allows an in-depth exploration of

dimensions of the phenomena, including its manifestations and related factors

(Cacanindin, 2010).

Data was gathered through personal interview by the use of a survey

questionnaire. A comprehensive analysis was presented showing the level of

awareness and the adoption of family planning. Careful analysis and proper

documentation of the results were of topmost consideration in this study. Any

data gathered during the interpersonal survey was instrumental in the

presentation of accurate results in relation to the focus of the study.

 46

Participants of the Study

Participants were handpicked to be included in the sampling frame

based on certain criteria for the purposes of the study. There was a total of

109 couples selected as participants through purposive sampling, wherein the

participants were all couples within reproductive age from 15 - 49 in the

selected barangay. Participants were viewed as typical cases that provided

enough data to answer the research questions (Cacanindin, 2010).

Instrumentation

The collection of data involved an interview, utilizing the developed

survey questionnaire to assess awareness and the common family planning

methods among the selected couples. Questionnaires were designed by the

researcher using the objectives of the study as the guide framework.

The questionnaire was composed of three parts: (1) Demographic

Profile, (2) Awareness Level, and (3) Family Planning Adoption. The content

of the instrument was adopted from the key concepts on family planning

methods based on “Family Planning: A Global Handbook for Providers”

(WHO, 2011).

A copy of the survey questionnaire was initially sent to the research

adviser for evaluation of questionnaire construction and corrections. Content

validity was done by distributing the developed survey questionnaire to

experts for critique and analysis.

 47

Pilot study was also conducted to seven families in a separately

identified barangay and results of which were treated with Cronbach’s Alpha

to measure internal consistency for reliability of the questionnaire and

resulted to 0.957 which is interpreted as having a very high internal

consistency.

Data-Gathering Procedure

This study was based on the answers of the personal interview of the

researcher to the participants residing within the targeted community.

Initially an official written of request noted by the Research Adviser

was handed to the Barangay Chairman seeking permission to conduct the

study.

Upon approval of the permit to conduct the study, personal interview

by the researcher was conducted to participants residing within the specified

community using the developed questionnaire to directly identify and clarify

responses that were not clear.

Results of the survey were then collated, processed and treated

statistically for proper analysis and interpretation.

 48

Statistical Treatment of Data

Data were analyzed using descriptive and inferential analysis. For the

descriptive analysis, the following statistical tools were adopted (de Guzman,

2008):

a) Percentage was utilized to identify the distribution or frequency of the

responses of the participants in the study.

b) Ranking was utilized to identify the hierarchy of the most common

methods utilized by the participants in the study.

c) Weighted Mean was utilized to measure central tendencies of the

responses in the study.

d) To compute for the degree of relationship (establish correlation) between

the level of awareness on family planning and demographic profile of

couples such as age, monthly income, number of children, and number

of years using family planning of the selected communities, the Pearson

– Product Moment Correlation Coefficient (Pearson – r) was used.

For the demographic profile such as educational attainment, occupation

and religion, which are categorical in nature, Eta correlation was used.

Interpretation of values obtained was as follows:

 49

Coefficient of Correlation Interpretation as to the Degree

of Relation

± 0.90 to 1.00 Very high correlation;

Very dependable relationship

± 0.70 to 0.89 High correlation;

Marked relationship

± 0.40 to 0.69 Moderate correlation;

Substantial relationship

± 0.20 to 0.39 Low correlation;

Definite but small relationship

Less than ± 0.20 Negligible correlation

0 No correlation

e) To test for the significance of the computed correlation coefficient

between the level of awareness and demographic profile of the couples

of the selected communities, T- Test for Dependent or Correlated

Means was utilized. A p-value less than 0.05 was then interpreted as

SIGNIFICANT.

f) A continuous rating scale was used to measure the extent of the Level of

awareness (Part II), as it offer distinct advantages over discrete scales

(Belz & Kow, 2011; Treiblmaier, H. & P. Filzmoser, 2009). The

participants were asked to give a rating at the appropriate position on a

continuous line with numerical value from 0 to 10. Such numerical values
 50

were then converted into percentile to accurately reflect a more sensitive

value for the interpretation of data. The following scale was used to

determine the appropriate values in the interpretation of mean scores.

Level of awareness (Part II)

MEAN RATE INTERPRETATION

8.0-10 Aware to great extent Knowledge or idea
regarding the subject
matter is vast with 80-
100% of information
known.

6.0-7.99 Aware Knowledge or idea

regarding the subject of
inquiry is sufficient of
about 60-70%

4.0-5.99 Moderately Aware Knowledge or idea

regarding the subject of
inquiry of about 40-59%

2.0 – 3.99 Aware subject of inquiry of

Slightly about 40 - 59 %
knowledge or idea
regarding the

0.0 – 1.99 Not Aware knowledge or idea

regarding the
subject of inquiry of
about 20 - 39 %
Does not have any
knowledge or idea
regarding the subject of
inquiry
 51

Chapter 4

PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA

This chapter presents the data in relation to the questions asked in the

study and their corresponding analysis and interpretation. The presentation is

organized on the basis of the questions asked.

I. Demographic Profile of the Participants

This study investigated the demographic profile among couple

participants in a selected barangay in Tacloban City. Table 1 presents the

profile distribution of these participants with respect to age range, religion,

educational attainment, occupation, monthly income, number of children, and

number of years using family planning (FP)

The table shows that most of the participants were within the age

range of 21 to 30 years old, comprising 46% or 50 out of 109 participants.

This is followed by age range of 31 to 40 years old, which is 27%. The least

number were under the age 20 and below with only 2 participants, or 2%. The

average age among the 109 participants was 34 years old. These finding

imply that most of the participants were in their right age for parenthood. This

also reflects that they were matured and capable to be part of the study.
 52

Table 1
Profile Distribution of Participants
Age Range Frequency Percent (%)
20 years old and below 2 2
21 – 30 years old 50 46
31 – 40 years old 30 27
41 – 50 years old 27 25
51 years old and above 0 0
Total 109 100.0
Religion
Roman Catholic 105 96
Born Again Christian 3 3
Protestant 1 1
Total 109 100.0
Educational Attainment
Elementary Level 6 5
Elementary Graduate 1 1
High School Level 26 24
High School Graduate 26 24
College Level 21 19
College Graduate 28 26
Post Graduate 1 1
Total 109 100.0
Occupation
None 24 22
Self Employed 52 48
Government Employee 7 6
Private Employee 26 24
Total 109 100.0
Monthly Income
5,000 & below 42 38
5,001 – 10,000 38 35
10,001 – 15,000 14 13
15,001 – 20,000 7 6
20,001 & above 8 7
Total 109 100.0
Number of Children
1–3 74 68
4–6 32 29
7–9 2 2
10 & above 1 1
Total 109 100.0
Number of Years Using FP
5 years & below 57 52
6 – 10 years 21 19
11 – 15 years 9 8
16 – 20 years 17 16
21 years & above 5 5
Total 109 100.0

It also shows that 105 or 96% of the participants were Roman Catholic.

While the remaining participants were Born Again Christian and Protestant,
 53

with 3 and 1 participants, respectively. This concurs with the 2008 NSO

findings that the Philippines is predominantly a Roman Catholic Nation with

Majority of which is Roman Catholic.

The table above shows that only 28 out of 109, or 26% of the

participants were college graduates. This is followed by High School Level

and High School Graduates, which comprise the same number of participants

at 24% each with 26 participants. While the least number of participants were

elementary graduate and post graduate, each have 1 respondent or 1%.

Though the college graduates comprised the highest percentage among the

categories, it actually is just a quarter of the entire population of the

participants - still a small part when taking into consideration that these are

individuals with families, thus could influences spousal fertility references

(Dewi, 2009).

The data show that most of the participants were self employed, which

comprise 48% or 52 of the 109 participants. These were composed of sari-

sari store owners, vendors, pedi cab drivers, fishermen, etc. This is followed

by employees in private companies which was 24% or 26 out of 109

participants. It also shows that 24 out of 109 participants or 22%, were

unemployed, and only 7 or 6.4% were government employees. The

occupation reflects the source of income of every couple. It is evident that

there was high unemployment in the said community.

 54

The table shows 38% or 42 out of 109 participants gained monthly

income of P5,000 and below. This is followed by 35% or 38 who had a

monthly income ranging from P5,001 to P10,000. The least number of

participants gained a monthly income ranging from P15,001 to P20,000, who

were only 7 or 6%. This reflects that the majority of the couples earned below

the poverty level income which is supposed to be between Php15, 000 –

Php20, 000 per month. It can be noted that the socio economic status of

couples can be a determinant in the application of family planning (Shah, et

al, 2008)

The presentation above shows that most of the participants, that is 74

out of 109 or 68%, had only a total of 1 to 3 children. This is followed by those

who had 4 to 6 children who comprise 29%. There was only 1 participant

having 10 and/or above number of children. As a result of these figures, an

average of 3 children was obtained from the participants.

As presented 52% of the participants, or 57 out of 109, had been using

family planning for 5 years and below. This is followed by those who applied

the same thing for 6-10 years, which was done by 21 or 19% of the

participants. The least number was those who had observed family planning

for 21 years and above, done by only 5 participants or 5%. It can be noted

that the result of the number of years of family planning practice may be

congruent with the age group of the participants of the study and perhaps

their awareness on the different methods of family planning.

 55

II. Level of Awareness among Participants on Family Planning

Table 2 below presents the results on the level of awareness of couple

participants on family planning.

Table 2

Level of Awareness among Participants on Family Planning Concepts

Family Planning Concepts MEAN Description

1. There is a family planning program 9.01 Aware to a great
promoted by the government? extent
2. There is a need for a family planning 9.69 Aware to a great
program? extent
3. Family planning may help to maintain a 9.42 Aware to a great
healthy mother and child? extent
4. Family planning may save lives? 9.22 Aware to a great
extent
5. With small number of children, you will 9.77 Aware to a great
have more time and money for extent
everyone
Overall Mean 9.42 Aware to a great
extent

As presented above, the participants were aware to a great extent on

the presence of a family planning program promoted by the government with

a mean of 9.01. This is a result of the government’s decade long effort on

information dissemination campaign on Family Planning Program and the

 56

current Reproductive Health Bill. The participants also recognized that there

was a need for a family planning program with a mean result of 9.69 and is

interpreted as being aware to great extent. They may have been direct or

indirect witnesses of the current population status thus recognize that a family

planning program may indeed be necessary. They were also aware to a great

extent, with a mean of 9.42 that the family planning program may help to

maintain a healthy mother and child thus save lives, having a mean of 9.22.

Finally, having a mean of 9.77, the participants were aware to a great

extent that there will be more time and money for everyone with a small

number of children. Their being a personal witness and personal experiences

on a larger family size could have helped them realize the economic effect of

proper family planning. Overall, it shows that couples were aware to the

great extent on the different Family Planning concepts being promoted by the

government.

Natural Family Planning

Discussion that follows presents the level of awareness of participants

on family planning categorized as Natural Method in Table 3 and Artificial

Method on Table 4.

Abstinence. The participants were aware to a great extent on

abstinence as the best way to prevent pregnancy and this method promotes

discipline and self concept having a mean result of 9.47 and 9.36

respectively. It shows that couples were more aware that there was a need
 57

for a sexual contact in order for them to produce offspring, a fundamental

knowledge regarding contraception.

Table 3
Level of Awareness of Participants on Family Planning
In Terms of Natural Method
Indicators WEIGHTED Description
MEAN
Abstinence
1. The best way to prevent pregnancy is abstinence 9.47 Aware to a
great extent
2. This method promotes discipline and self concept 9.36 Aware to a
great extent
Sub-Mean 9.41 Aware to a
great extent
Coitus Interuptus/Withdrawal
1. There will be no pregnancy when the penis is 7.89 Aware
withdrawn and ejaculation is done outside the vagina
2. This method requires time to learn 8.31 Aware
3. This might not be effective to male who cannot control 8.20 Aware
their ejaculation
Sub-Mean 8.13 Aware
Calendar/Rhythm/Standard Days Method
1. Pregnancy may be prevented by not having coitus 6.44 Moderately
during identified fertile days Aware
2. The 8th – 19th day of every cycle are the days that 5.66 Moderately
females are fertile Aware
3. This method does not have side effects 5.99 Moderately
Aware
Sub-Mean 6.03 Moderately
Aware
Mucous/Billings/Ovulation Method
1. There will be no pregnancy when coitus is done during 2.42 Not Aware
observed infertile days
2. This can be used by any women as long as there is no 2.38 Not Aware
unusual condition that result in extraordinary vaginal
discharges
3. There should be regular observation for presence of 2.42 Not Aware
mucous and observation of fertile days characteristics
Sub-Mean 2.41 Not Aware
Lactating Amenorrhea Method
1. That breastfeeding will help prevent pregnancy 3.67 Slightly Aware
2. There is a proper practice for this method to be 3.72 Slightly Aware
effective
3. This method is effective up to six months after delivery 2.91 Not Aware
Sub-Mean 3.43 Slightly Aware
 58

Coitus interruptus / Withdrawal. With a mean of 7.89, participants

were aware that with coitus interruptus or withdrawal, there would be no

pregnancy when the penis is withdrawn and ejaculation is done outside the

vagina. With a mean of 8.31, participants were aware that this method

required time to learn and this might not be effective for males who cannot

control their ejaculation as shown by a mean of 8.20.

Calendar/rhythm/standard days method. It can be noted that with a

mean of 6.44, participants were moderately aware that pregnancy may be

prevented by not having coitus during identified fertile days. They recognized

as moderately aware as well that the 8th – 19th day of every cycle were the

days that females are fertile and the practice of this method did not have side

effects as shown by a mean of 5.66 and 5.99 respectively. The technicalities

of this method could have affected the participant’s awareness as this method

needs a lot of base information for them to be able to understand.

Mucous/billings/ovulation method. This method is not considered as

a familiar natural family planning method practice as participants were not

aware that there would be no pregnancy when coitus is done during observed

infertile days. They were also not aware that it could be used by any woman

as long as there is no unusual condition that results in extraordinary vaginal

discharges, and that it needs regular observation for presence of mucous and

observation of fertile day’s characteristics having mean results of 2.42, 2.38,

and 2.42 respectively.

 59

Lactating amenorrhea method. With a mean of 3.67 and 3.72

respectively, participants were just slightly aware that breastfeeding would

help prevent pregnancy and there was a proper practice for this method to be

effective. Having a mean of 2.91, it shows that the participants were not

aware that this method is effective up to six months after delivery. Though

breastfeeding was a practice of newly delivered mothers, the couples did not

recognize its importance and relationship to natural family planning method.

Artificial Family Planning

Pills. With a mean of 9.28 and 9.01 respectively, participants were

aware to a great extent that pills could be utilized to prevent pregnancy, and

that pills were a more effective method but needed to be utilized properly. But

when interviewed on whether pills were taken everyday and the possible

effects of pills on the body, a mean of 7.12 and 7.73 respectively shows that

participants were aware of it. An 8.29 overall sub-mean reflects that

participants were aware of birth control pills as a means of contraception. The

data collected shows that the government’s campaign on family planning on

the concepts of pills as a contraceptive is effective, but awareness on its

utilization and on its possible effects is not as much.

 60

Table 4
Level of Awareness among Participants on Family Planning
In Terms of Artificial Method
Indicators WEIGHTED Description
MEAN
Birth Control Pills
1. Pills can be utilized to prevent pregnancy? 9.28 Aware to a great extent
2. Pills are more effective method but needs to be 9.01 Aware to a great extent
utilized properly
3. Pills are taken every day 7.12 Aware
4. There are possible effects of pills on your body 7.73 Aware
Sub-Mean 8.29 Aware
Injectables
1. There are Injections that can be utilized to prevent 8.77 Aware
pregnancy?
2. This is a more effective method but should be done in 8.25 Aware
the appropriate time and frequency
3. Injection is administered every 3 months 5.67 Moderately Aware
4. There are possible effects of injectables on your body 6.83 Moderately Aware
Sub-Mean 7.38 Aware
Condom
1. Condoms can be utilized to prevent pregnancy? 7.54 Aware
2. Male condom and female condoms are different 5.47 Moderately Aware
3. This is effective but needs to be utilized properly 6.59 Moderately Aware
4. There is a proper way of wearing condoms before 6.27 Moderately Aware
every intercourse
Sub-Mean 6.47 Moderately Aware
IUD
1. IUDs can be utilized to prevent pregnancy? 4.19 Slightly Aware
2. This is very effective and is easier to use 3.70 Slightly Aware
3. Do you know how IUDs are used and inserted? 2.39 Not Aware
Sub-Mean 3.43 Slightly Aware
Bilateral Tubal Ligation
1. Ligation may be a means of preventing pregnancy 9.83 Aware to a great extent
2. This is very effective but is permanent 9.53 Aware to a great extent
3. This method is a surgical procedure done in hospitals 9.50 Aware to a great extent
4. There are possible complications this procedure may 9.06 Aware to a great extent
have
Sub-Mean 9.48 Aware to a great extent
Vasectomy
1. Male ligation may be a means of preventing 6.35 Moderately Aware
pregnancy
2. This is very effective but is permanent 5.91 Moderately Aware
3. This method is a surgical procedure done in hospitals 6.16 Moderately Aware
4. There are possible complications this procedure may 5.78 Moderately Aware
have
5. This is very effective and is easier to utilize 5.87 Moderately Aware
Sub-Mean 6.01 Moderately Aware

Injectables. Data shows that participants were aware that there were

Injections that can be utilized to prevent pregnancy and it was a more

 61

effective method but should be done in the appropriate time and frequency

with a mean of 8.77 and 8.25 respectively. But with regards to its

administration every 3 months and the presence of possible effects in the

body, participants were moderately aware having a mean of 5.67 and 6.83

respectively. It shows that participants were generally aware on the

injectables as a method of family planning as reflected by a sub-mean of

7.38.

Condom. Participants were aware with a mean of 7.54 that condoms

could be utilized to prevent pregnancy. When asked if male condom and

female condoms were different, if it was effective but needed to be utilized

properly, and if there was a proper way of wearing condoms before

intercourse, participants showed moderate awareness with a mean of 5.47,

6.59, and 6.27 respectively. A sub-mean of 6.47 may then be interpreted that

participants were moderately aware of condom utilization as an effective

means of contraception. Though condoms are commonly advertized as a

contraceptive device, the participant’s awareness on its proper utilization is

not at full extent.

IUD. Participants were slightly aware that IUDs could be utilized to

prevent pregnancy, and that it was very effective and easier to use with

means of 4.19 and 3.70 respectively. With a mean of 2.39, participants were

not aware how IUDs were used and inserted. With little information regarding
 62

this as one of the uncommon family planning method, a sub-mean of 3.43

shows that participants were only slightly aware about it.

Bilateral Tubal Ligation. With a mean of 9.83, results shows that the

participants were aware to a great extent that bilateral tubal ligation may be a

means of preventing pregnancy. They were also aware to a great extent that

it is very effective but was permanent, and that this was done in the hospitals

and possible complications might arise from this procedure with a mean of

9.53, 9.50, and 9.06 respectively. A sub-mean of 9.48 means that the

participants were aware to a great extent on the different concepts regarding

bilateral tubal ligation.

Vasectomy. With a mean of 6.35, 5.91, it is shown here that

participants were moderately aware on male ligation as means of preventing

pregnancy and that it was effective but permanent. They were also

moderately aware that it was a surgical procedure done in hospitals and that

there were possible complications the procedure may have, with a mean of

6.16, and 5.78 respectively. A sub-mean of 6.01 means that participants were

moderately aware on vasectomy.

In summary, as reflected in Table 5, for the natural method of family

planning, it can be noted that abstinence ranked 1st with the highest sub-

mean of 9.41 which indicates that couples were aware to a great extent on

abstinence as a means of contraception. Coitus Interruptus / withdrawal

ranked 2nd with a sub-mean of 8.13 and interpreted as aware. Calendar

 63

Method / Rhythm / Standard Days Method, Lactating Amenorrhea Method,

and Mucous / Billings / Ovulation Method came 3rd, 4th, and 5th with sub-

means of 6.03 which is interpreted as moderately aware, 3.43 as slightly

aware, and 2.41 as not aware respectively.

Table 5

Summary and Ranking of Awareness on Natural

and Artificial Family Planning Method

Rank Natural Family Planning Method Sub-Mean Description

1 Abstinence 9.41 Aware to a great
Extent
2 Coitus Interuptus / Withdrawal 8.13 Aware
3 Calendar Method / Rhythm / 6.03 Moderately
Standard Days Method Aware
4 Lactating Amenorrhea Method 3.43 Slightly Aware
5 Mucous / Billings / Ovulation 2.41 Not Aware
Method
Rank Artificial Family Planning Method Sub-Mean Description
1 Bilateral Tubal Ligation 9.48 Aware to a Great
Extent
2 Birth Control Pills 8.29 Aware
3 Injectables 7.38 Aware
4 Condom 6.47 Moderately
Aware
5 Vasectomy 6.01 Moderately
Aware
6 IUD 3.43 Slightly Aware
 64

As shown in Table 5 for the artificial method, Bilateral Tubal Ligation

ranked 1st with the highest mean of 9.48, which means that couples were

aware of it to a great extent. With a sub-mean of 8.29 and 7.38, Birth Control

Pills and Injectables both ranked 2nd and 3rd, and represent that couples were

aware of it. Couples were moderately aware on both Condom and Vasectomy

as reflected by sub-means of 6.47 and 6.01, and were ranked 4th and 5th

respectively. It is immediately followed by IUD with a sub-mean of 3.43 which

means that couples were just slightly aware of IUDs.

III. Family Planning Practices among Participants

Discussions that follow present the family planning practices that the

couple participants used. Results are presented in Table 5.

Table 6

Family Planning Practices *

Rank Natural Family Planning Practices Percent

1 Abstinence 98
2 Withdrawal 83
3 Standard Days Method 43
4 Lactation Amenorrhea Method 29
5 Mucous method 4
Rank Artificial Family Planning Practices Percent
1 Condom 25
2 Pills 19
3 Bilateral Tubal Ligation 17
4 Injections 5
5 IUD ( and Frequency of consultation) 1
6 Vasectomy 1
(*) Multiple responses
 65

Natural Family Planning Method. Abstinence was the most common

NFP method practiced by 107 of 109 or 98%. It is followed by Withdrawal

Method practiced by 90 or 83%, Standard Days method by 47 or 43%, and

Lactation Amenorrhea Method by 3 or 29%. The least being practiced family

planning method is the Mucous Method which was done only by 4 or 4% of

the participants. It could be noted that participants did not only adhere to one

type of method but rather a variety or sometimes maybe a combination of all

family planning methods. In general, the results concur with Kinkaid’s (2006)

observation that the family planning method most commonly practiced by the

participants are those that are “Easy to adopt” methods and those that do not

require remembering or a lot of poking/looking into private parts. In the

mucous method, it requires an understanding of bodily functions (Andrews, et

al, 2008), which makes it difficult to practice.

Artificial Family Planning Method. The use of condom was the most

common artificial family planning method used by 27 participants or 25%. It is

followed by use of pills with 21 participants or 19%. Bilateral Tubal Ligation

done to 18 participants or 17% and injections to 5 or 5% of the participants

follows consecutively. With only 1 or 1% each who had IUD and Vasectomy, it

is the method least commonly practiced by the participants. The participant

who had IUD claimed to have medical consultation done every 3 months. The

results support the NSO (2009) results that the most commonly known

methods are the pills, male condom, female sterilization, and injectables. This
 66

also reflects that the commonly used contraceptives are those that are easy

to use, readily available and accessible in the market. It can also be noted as

well that the more invasive the procedure is, the least it is being practiced by

couples.

IV. Relationship between Participants’ Level of Awareness on Family

Planning and Demographic Profile

The study determined and tested the significant relationship between

couple participants’ level of awareness on family planning and their

demographic profile. Table 7 below presents the results.

Age. Table 7 shows that of the eleven family planning practices

correlated to demographic variable age, none of these showed to be

significant. Hence, the null hypothesis of no significant relationship was not

rejected at the 5% level of significance. This result implies that age of the

participants has nothing to do with their choice on what family planning

practices they are going to use. This result contradicts Sharma’s (2012)

findings. This may be attributed to the wide age range of health education

conducted to the community by DOH and other NGOs in support of the family

planning program of the government.

Religion. In Table 7, of the eleven family planning practices correlated

to demographic variable religion, only two showed to be significant. For the

Natural Method, only Mucous/Billings/Ovulation Method showed to be

significant with a correlation coefficient of 0.216 with a corresponding p-value

 67

of 0.024. Hence, the null hypothesis of no significant relationship was rejected

at the 5% level of significance. This result implies that religion of the

participants had influenced on the awareness of ovulation method as their

practice for family planning.

Table 7

Significant Relationship between Participant’s Level of Awareness on

Family Planning and Demographic Profile

Variables Correlation Degree of p- Decision Interpretation

Coefficient Correlation value
AGE and
Abstinence -0.072 Negligible 0.458 Accept Ho Not Significant
Coitus Interuptus/Withdrawal -0.053 Negligible 0.584 Accept Ho Not Significant
Calendar/Rhythm/Standard Days -0.062 Negligible 0.520 Accept Ho Not Significant
Method 0.105 Negligible 0.276 Accept Ho Not Significant
Mucous/Billings/Ovulation Method 0.043 Negligible 0.655 Accept Ho Not Significant
Lactating Amenorrhea Method 0.022 Negligible 0.817 Accept Ho Not Significant
Birth Control Pills 0.075 Negligible 0.435 Accept Ho Not Significant
Injectables -0.074 Negligible 0.444 Accept Ho Not Significant
Condom 0.142 Negligible 0.141 Accept Ho Not Significant
IUD -0.005 Negligible 0.959 Accept Ho Not Significant
Bilateral Tubal Ligation 0.107 Negligible 0.269 Accept Ho Not Significant
Vasectomy
EDUCATIONAL ATTAINMENT and
Abstinence 0.213 Low 0.564 Accept Ho Not Significant
Coitus Interuptus/Withdrawal 0.384 Low 0.011 Reject Ho Significant
Calendar/Rhythm/Standard Days 0.450 Low 0.001 Reject Ho Significant
Method 0.413 Moderate 0.000 Reject Ho Significant
Mucous/Billings/Ovulation Method 0.373 Low 0.000 Reject Ho Significant
Lactating Amenorrhea Method 0.158 Negligible 0.102 Accept Ho Not Significant
Birth Control Pills 0.201 Low 0.036 Reject Ho Significant
Injectables 0.113 Negligible 0.241 Accept Ho Not Significant
Condom 0.448 Moderate 0.000 Reject Ho Significant
IUD 0.048 Negligible 0.681 Accept Ho Not Significant
Bilateral Tubal Ligation 0.266 Low 0.005 Reject Ho Significant
Vasectomy
OCCUPATION and
Abstinence 0.098 Negligible 0.309 Accept Ho Not Significant
Coitus Interuptus/Withdrawal 0.135 Negligible 0.162 Accept Ho Not Significant
Calendar/Rhythm/Standard Days 0.028 Negligible 0.772 Accept Ho Not Significant
Method 0.263 Low 0.006 Reject Ho Significant
Mucous/Billings/Ovulation Method 0.172 Negligible 0.074 Accept Ho Not Significant
Lactating Amenorrhea Method 0.209 Low 0.029 Reject Ho Significant
Birth Control Pills 0.059 Negligible 0.561 Accept Ho Not Significant
Injectables 0.089 Negligible 0.355 Accept Ho Not Significant
Condom 0.135 Negligible 0.162 Accept Ho Not Significant
IUD -0.050 Negligible 0.604 Accept Ho Not Significant
Bilateral Tubal Ligation 0.143 Negligible 0.138 Accept Ho Not Significant
Vasectomy
 68

Variables Correlation Degree of p- Decision Interpretation

Coefficient Correlation value
RELIGION and
Abstinence -0.016 Negligible 0.872 Accept Ho Not Significant
Coitus Interuptus/Withdrawal 0.040 Negligible 0.683 Accept Ho Not Significant
Calendar/Rhythm/Standard Days 0.117 Negligible 0.226 Accept Ho Not Significant
Method 0.216 Low 0.024 Reject Ho Significant
Mucous/Billings/Ovulation Method 0.166 Negligible 0.085 Accept Ho Not Significant
Lactating Amenorrhea Method 0.031 Negligible 0.751 Accept Ho Not Significant
Birth Control Pills 0.038 Negligible 0.696 Accept Ho Not Significant
Injectables 0.181 Negligible 0.060 Accept Ho Not Significant
Condom 0.203 Low 0.034 Reject Ho Significant
IUD -0.060 Negligible 0.535 Accept Ho Not Significant
Bilateral Tubal Ligation 0.067 Negligible 0.491 Accept Ho Not Significant
Vasectomy
MONTHLY INCOME and
Abstinence 0.050 Negligible 0.604 Accept Ho Not Significant
Coitus Interuptus/Withdrawal -0.006 Negligible 0.949 Accept Ho Not Significant
Calendar/Rhythm/Standard Days 0.122 Negligible 0.207 Accept Ho Not Significant
Method 0.285 Low 0.003 Reject Ho Significant
Mucous/Billings/Ovulation Method 0.311 Low 0.001 Reject Ho Significant
Lactating Amenorrhea Method -0.190 Negligible 0.048 Reject Ho Significant
Birth Control Pills -0.102 Negligible 0.290 Accept Ho Not Significant
Injectables 0.199 Negligible 0.038 Reject Ho Significant
Condom 0.225 Low 0.019 Reject Ho Significant
IUD -0.045 Negligible 0.639 Accept Ho Not Significant
Bilateral Tubal Ligation 0.141 Negligible 0.145 Accept Ho Not Significant
Vasectomy
NUMBER OF CHILDREN and
Abstinence -0.020 Negligible 0.839 Accept Ho Not Significant
Coitus Interuptus/Withdrawal -0.102 Negligible 0.290 Accept Ho Not Significant
Calendar/Rhythm/Standard Days 0.068 Negligible 0.482 Accept Ho Not Significant
Method 0.006 Negligible 0.951 Accept Ho Not Significant
Mucous/Billings/Ovulation Method 0.002 Negligible 0.985 Accept Ho Not Significant
Lactating Amenorrhea Method -0.163 Negligible 0.090 Accept Ho Not Significant
Birth Control Pills 0.090 Negligible 0.354 Accept Ho Not Significant
Injectables -0.046 Negligible 0.634 Accept Ho Not Significant
Condom 0.088 Negligible 0.364 Accept Ho Not Significant
IUD 0.134 Negligible 0.165 Accept Ho Not Significant
Bilateral Tubal Ligation 0.110 Negligible 0.255 Accept Ho Not Significant
Vasectomy
NUMBER OF YEARS USING FAMILY
PLANNING and
Abstinence -0.084 Negligible 0.387 Accept Ho Not Significant
Coitus Interuptus/Withdrawal -0.093 Negligible 0.337 Accept Ho Not Significant
Calendar/Rhythm/Standard Days -0.102 Negligible 0.292 Accept Ho Not Significant
Method 0.105 Negligible 0.276 Accept Ho Not Significant
Mucous/Billings/Ovulation Method 0.008 Negligible 0.933 Accept Ho Not Significant
Lactating Amenorrhea Method -0.043 Negligible 0.657 Accept Ho Not Significant
Birth Control Pills 0.033 Negligible 0.736 Accept Ho Not Significant
Injectables -0.122 Negligible 0.205 Accept Ho Not Significant
Condom 0.103 Negligible 0.285 Accept Ho Not Significant
IUD -0.069 Negligible 0.474 Accept Ho Not Significant
Bilateral Tubal Ligation 0.066 Negligible 0.498 Accept Ho Not Significant
Vasectomy

With regards to the Artificial Method, the awareness of IUD showed to

be significant with a correlation coefficient value of 0.203 and p-value of

 69

0.034. Hence, the null hypothesis of no significant relationship was rejected at

the 5% level of significance. This result implies that religion of the

participants had influenced on the awareness of IUD as their practice for

family planning.

As a predominantly Roman Catholic country (NSO, 2008) the result

concurs with Dewi’s (2009) analysis that culture do influences attitude

towards family planning. It also somehow affirms that Catholicism least likely

approve the use of artificial family planning (Yeatman & Trinitapoli, 2008)

which could have influenced the participants awareness.

Educational Attainment. It is represented in Table 7 that of the

eleven family planning practices correlated to demographic variable

educational attainment, seven of these showed to be significant. For the

Natural Method, Coitus Interuptus/Withdrawal, Calendar/Rhythm/Standard

Days Method, Mucous/ Billings/Ovulation Method, and Lactating Amenorrhea

Method showed to be significant with correlation coefficient values of 0.303,

0.385, 0.413 and 0.373, respectively. These values were tested using t-test

with p-values of 0.001, 0.000, 0.000 and 0.000, respectively. Hence, the null

hypotheses of no significant relationships among these practices were

rejected at the 5% of significance. These results implies that the higher the

educational attainment of the participants the higher is their awareness of the

said family planning method, an acceptable premise as these are considered

 70

to be more technical in terms and in the methods on how to practice these

methods.

With regards to the Artificial Method, Birth Control Pills, IUD and

Vasectomy showed to be significant with correlation coefficient values of

0.201, 0.448 and 0.266, respectively. These values were tested using t-test

with p-values of 0.036, 0.000 and 0.005, respectively. Hence, the null

hypotheses of no significant relationships among these practices were

rejected at the 5% of significance. These results imply that the higher the

educational attainment of the participants the higher is their awareness of the

said family planning practices.

The results supports Guria’s (2009) analysis that knowledge, attitude

and practices (KAP) about family planning is noted to be high in educated

family. Inclusion of family planning practices in school curricula could have led

to the increase awareness as educational attainment increases which brings

light and in depth understanding of the methods.

Occupation. It can be gleaned from Table 7 that of the eleven family

planning practices correlated to demographic variable occupation, only two of

these showed to be significant. For the Natural Method, only

Mucous/Billings/Ovulation Method showed to be significant with a correlation

coefficient value of 0.263 and a p-value of 0.006. Hence, the null hypothesis

of no significant relationship was rejected at the 5% level of significance. This

 71

result implies that occupation showed to influence the awareness of the said

natural method of family planning.

As for the Artificial Method, the use of Birth Control Pills showed to be

significant with a correlation coefficient value of 0.209 and a corresponding p-

value of 0.029. Hence, the null hypothesis of no significant relationship was

rejected at the 5% level of significance. This result implies that occupation

showed to influence the awareness of the said artificial method of family

planning.

Occupation is a socio-economic factor that could influence awareness

on family planning methods (Shah, et. al, 2008). The type of occupation could

emanate from the level of educational attainment the participants have. As

with the results, there should have been adequate knowledge regarding the

use of both Mucous/Billings/Ovulation Method and birth control pills to affect

the participants level of awareness.

Monthly Income. Of the eleven family planning practices correlated to

demographic variable monthly income, in Table 7, five of these showed to be

significant. As for the Natural Method, Ovulation Method and Lactating

Amenorrhea Method showed to be significant with a correlation coefficient of

0.285 and 0.311, respectively. These values were further tested using t-test

which obtained p-values of 0.003 and 0.001, respectively. Hence, the null

hypothesis of no significant relationship was rejected at the 5% level of

 72

significance. This result implies that the higher the income of the participants

the higher the awareness of these two Natural Methods of family planning.

With regards to the Artificial Method, Birth Control Pills, Condoms, and

IUD showed to be significant with correlation coefficient of -0.190, 0.199 and

0.225, respectively. These values were further tested and obtained p-values

of 0.048, 0.038 and 0.019, respectively. Hence, the null hypothesis of no

significant relationship was rejected at the 5% level of significance. This

result implies that income of the participants influenced their awareness of the

three Artificial Methods of family planning.

Results supported the claim of Guria, et. al. (2009) that awareness

level on the different methods of family planning was noted to be of significant

difference between upper-middle and low-socio economic groups. Socio-

economic status are indirect indicators on the level of education as higher

socio economic status would indicate the ability of the couples to access

information regarding family planning methods.

Number of Children. It is shown in Table 7 that of the eleven family

planning practices correlated to demographic variable number of children,

none of these showed to be significant. Hence, the null hypothesis of no

significant relationship was accepted at the 5% level of significance. This

result implies that number of children has nothing to do with their awareness

and choice on what family planning practices they are going to use.
 73

The number of children the couples have does not influence their

awareness of any family planning methods. It may have affected the couple’s

interest for its use but results show that with regards to their awareness, it has

no impact.

Number of years using family planning. From the data in Table 7,

of the eleven family planning practices correlated to demographic variable

number of years using family planning, none of these showed to be

significant. Hence, the null hypothesis of no significant relationship was

accepted at the 5% level of significance. This result implies that the number

of years using family planning of the participants has nothing to do with their

awareness and choice on what family planning practices they are going to

use. Even if the couples are using family planning for a longer time, it does

not prove that it would increase their awareness on all or specific family

planning methods they are adopting, as it does not guarantee correct

practices.
 74

Chapter 5

SUMMARY, CONCLUSION, AND RECOMMEDATION

This study was conducted in order to assess the level of awareness

and practices of family planning methods among couples in a selected

Barangay in Tacloban City. In this study answer to the following questions

were sought:

1. What is the demographic profile of the participants in terms of:

1.1 Age,

1.2 Religion,

1.3 Educational Attainment,

1.4 Occupation,

1.5 Monthly Income,

1.6 No. of children, and

1.7 No. of years using family planning?

2. What is the level of awareness of the participants on family planning in

terms of:

2.2. Natural Method and

2.3. Artificial Method?

3. What Family Planning methods are commonly practiced by the

couples?
 75

4. Is there a significant relationship between the participant’s level of

awareness and demographic profile?

5. Based from the results of the study, what strategies can be made to

enhance the family planning program.

The data were gathered from the representative of one of the couple

through interview method with the use of a questionnaire. The statistical

treatment utilized were percentage, ranking, weighted mean, Pearson-r, Eta

Correlation, and t-test of dependent means.

Summary of Findings

1. Profile of the Participants.

The age range of the participants is from 15 – 49 years old. The

bulk of the participants were within the ranges of 21-30 and 31-40. The

least number came from 20 years old and below.

Majority of the participants were Roman Catholic. There were only

a small percentage of Born Again Christians and Protestants.

The highest educational attainment was post graduate followed by

college graduates. The lowest educational attainment was at elementary

level.

Most of the participants were self-employed and the least were

those coming from government service.

 76

Most of the participants earned P5,000 and below. Only a small

percentage had a monthly income ranging from P15,001 to P20,000.

Of the 109 participants, majority had 1-3 children, a least number of

participants were observed to have more than 10 children. In turn, couples

had been practicing family planning mostly for 5 years and below, and It

was least practiced by those aging 21 years and above.

2. Level of Awareness

a. Natural Family Planning

Data shows that couples of the selected community were aware to

a great extent on abstinence. It also shows that couples were

aware on coitus interruptus / withdrawal. On the other hand,

participants were just moderately aware on

Calendar/Rhythm/Standard Days Method, and in terms of Lactating

Amenorrhea method, participants were slightly aware of it while

they were not aware on Mucous/Billings/Ovulation Method.

b. Artificial Family Planning

The couples’ highest level of awareness was on bilateral tubal

ligations which show that they were aware of it to a great extent.

They were then aware on Pills and Injectables, and moderately

aware on condom usage and vasectomy. The IUD got the least

sub-mean and is interpreted as just slightly aware.

 77

3. Commonly Practiced Family Planning Methods

In natural family planning, the most commonly used method was

Abstinence. It was followed by withdrawal, then by the standard days

method, lactation amenorrhea method, and lastly the mucous method.

In Artificial family planning on the other hand, condom use was

the most common method used. Pills usage ranked next and was

followed by Bilateral Tubal Ligation and injections. IUD and Vasectomy

were the least common methods practiced by the participants. IUD

consultation was noted to be done once every three months.

4. Relationship between the Participants’ Level of Awareness and

Demographic Profile

Of all the demographic profile, only the following are shown to

be significant. Hence, the null hypothesis of no significant relationship

was rejected at the 5% level of significance:

Religion

For the Natural Method, only Mucous/Billings/Ovulation Method

showed to be significant. And with regards to the Artificial Method, the

awareness of IUD showed to be significant.

Educational Attainment

For the Natural Method, Coitus Interuptus/Withdrawal,

Calendar/Rhythm/Standard Days Method, Mucous/ Billings/Ovulation

Method, and Lactating Amenorrhea Method showed to be significant.

 78

With regards to the Artificial Method, Birth Control Pills, IUD and

Vasectomy showed to be significant.

Occupation

For the Natural Method, only Mucous/Billings/Ovulation Method

showed to be significant and as for the Artificial Method, the use of

Birth Control Pills showed to be significant.

Monthly Income

As for the Natural Method, the Ovulation Method and Lactating

Amenorrhea Method showed to be significant. With regards to the

Artificial Method, Birth Control Pills, Condoms, and IUD showed to be

significant.

Conclusions

Based on the results of the study, the researcher concludes that:

1. The more common and easy to practice natural family planning

methods which include abstinence, withdrawal, and standard days

method, the higher is the couple’s awareness level. On the other hand,

the easier to use and readily available artificial family planning method

that includes bilateral tubal ligation, use of pills, injectables, and

condom, the higher is the couple’s level of awareness.

2. Easy to practice Natural family planning methods are the most

observed method in the community to include abstinence and

 79

withdrawal. The more complicated the method becomes; the least

likely it will be practiced by couples.

3. Condoms, pills, bilateral tubal ligation, and injection which are more

accessible and readily available artificial family planning methods in

the community are the most chosen and utilized by the couples.

4. Age, number of children, and no. of years using family planning does

not affect the couple’s level of awareness but is rather affected by

religion, educational attainment, occupation, and monthly income.

5. Religion being a cultural aspect does influence awareness on specific

family planning methods which includes ovulation method and IUD

use.

6. Educational attainment influence awareness on highly technical family

planning methods that needs deeper understanding which includes

Coitus Interuptus / Withdrawal, Calendar/Rhythm/Standard Days

Method, Mucous/ Billings/Ovulation Method, Lactating Amenorrhea

Method, Birth Control Pills, IUD and Vasectomy.

7. Occupation influences Mucous/Billings/Ovulation Method and Birth

Control Pills and monthly income influence awareness on Ovulation

Method, Lactating Amenorrhea Method Birth Control Pills, Condoms,

and IUD. Thus, the higher socio-economic status couples have the

more access to the information and somehow interest on these family

planning methods there is.

 80

Recommendations

Based on the results of the study, the researcher recommends the

following:

1. The Mother and Child Nurses Association of the Philippines, Leyte

Chapter (MCNAP) should include the following in their family planning

program service to their adopted community:

a. Reiterate and enforce the importance of family and the practice of

the natural family planning methods which are safer and less

expensive to utilize.

b. Once couples have decided to practice family planning, they should

approach the organization and available barangay healthcare

professionals for proper health education and counseling on the

appropriate family planning methods to be utilized.

c. There should be specific healthcare professionals assigned or

delegated by the organization, the task to take charge and focus on

the family planning program that is readily available for health

education and counseling.

d. Support the development of educational material / visual aid

translated in local vernaculars to promote greater understanding

and awareness in the different family planning methods.

e. It is also recommended that information dissemination through

the use of IEC material such as brochure and pamphlets be

 81

utilized to promote standard day, lactating amenorrhea, and

ovulation methods to increase awareness and practice of this

type of natural family planning method.

f. Family planning education program should be conducted most

specially to couples of different religions who are less educated,

unemployed, and to those with low monthly income.

g. Propose a health education program action plan designed to

enhance and increase the level of awareness and reinforce the

family planning methods and practices of target population.

2. For future researchers, this study may be replicated using bigger

samples that would reflect family planning practices in the city and the

whole region in general.

 82

Proposed Health Education Program Action Plan To Increase

Awareness On Family Planning Methods Among Couples

Overview

With an increasing population size in the Philippines, responsible

parenthood should be encouraged. There should be an increased awareness

on the different family planning methods to give couples a varied choice of the

methods which are safe and deemed appropriate to their stature. In support

to increasing Knowledge and Attitude regarding family planning, the conduct

of health education was found to be an effective means (Baul, 2008).

This health education action plan is designed to ensure an increased

family planning methods awareness of couples in the selected barangay in

Tacloban City. This will be implemented through health education that would

make them informed and have safe decisions about family planning practices.

It is designed in such way to fully cover the education of all target couples of

the specified community.

The education plan is designed to be conducted for two days (12

hours) every weekend for one month. The time frame is so designed to

adequately impart information without taking much toll on the couple’s time for

their daily activities and a month time is then deemed adequate to cover all

the target couples of the barangay.

 83

General Objectives

After the implementation of this health education action plan, couples

must be able to describe the different family planning methods being

emphasized along with other pertinent concepts that would affect their

utilization

Proposed Budget

Honorarium for Guest Lecturer P 4800.00

Refreshment for the Participants P 3000.00

Hand-outs and Materials P 3000.00

Total P10, 800.00

 84

NATURAL FAMILY PLANNING METHOD

Key Result Person/s Expected

Objectives Strategy Time
Areas in Charge Outcome
At the end of the 6 DIDACTIC 3 Lecturer 1. Increase
hours of health Hours knowledge
education, Round Table actions & views
participants will be Discussion of participants to
1. Mucuos able to: a minimum of 75
Methods Movie clip %
1. Discuss the presentation
different 2. Establish core
Natural Family Use of visual group activities
Planning aid and partnership
Methods with the
2. Standard community
Days 2. Describe the
Methods concept WORKSHOP 3 MCNAP 3. Increase
behind every Hours Facilitator practices of the
Method Jig-saw puzzle specific family
planning method
3. Identify factors Role Playing
affecting the
3. Lactation different Return
Amenorrhea methods Demonstration
Method
(LAM) 4. Cite
advantages &
disadvantages
of each
method

5. Identify the
percentage of
effectiveness
of every
method

6. Demonstrate
the correct use
of natural
family planning
method
 85

ARTIFICIAL FAMILY PLANNING METHOD

Key Result Person/s Expected

Objectives Strategy Time
Areas in Charge Outcome

At the end of the 6 DIDACTIC 3 Lecturer 1. Increase

hours of health Hours knowledge
education, Round Table actions & views
participants will be Discussion of participants
1. Vasectomy able to: .to a minimum of
Movie clip 75 %
1. Discuss the presentation
different 2. Establish core
Artificial Family Use of visual group activities
Planning aid and partnership
2. IUD Methods with the
(Intrauterine Actual sample community
Device) 2. Describe the
concept behind WORKSHOP 3 MCNAP 3. Increase
every Method
Hours Facilitator practices of the
Demonstration specific family
3. Identify the
different types thru dummy or planning method
3. Condoms of artificial the like
family planning
methods Return
Demonstration
4. Cite
advantages &
disadvantages
of each
methods

5. Determine
potential side
effects and
contraindication
s

6. Identify
percentage of
effectiveness of
each methods

7. Demonstrate
the correct use
of artificial
family planning
method devices
 86

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Dewi, V. (2009), “Factors that Influence Male Participation in Family Planning and

Reproductive Health in Indonesia”, Thesis presented to the Graduate

Program in Applied Population Studies School of Geography, Population and

Environmental Management, The Flinders University of South Australia,

Adelaide

Dhingra, Rajini et. al. (2010), “Attitudes of couples towards family planning.” P.G.

Department of Home Science, University of Jammu, Jammu 180 006, Jammu

and Kashmir, India.

Frank- Hermann, P., et. al. (2007), “The effectiveness of a fertility awareness based

on a method to avoid pregnancy in relation to a couple’s sexual behavior

during the fertile time: a prospective longitudinal study. Human

Reproduction”, 22 (5), 1310- 1319.

Guria, M., et. al. (2009), “Awareness Level of Family Planning Practices in School

Going Adolescent Girls of Different Socio-economic Groups in Rural Sectors,

West Bengal”, Department of Bio-Medical Laboratory Science & Management

(UGC Innovative Programme Funded Department), Vidyasagar University,

Midnapore 721 102, West Bengal, India

Hajian-Tilaki, Ko (2009) “The patterns and determinants of birth intervals in

multiparous women in Babol Northern Iran.”

 92

Hashem, A. (2009), “Family Planning Program Effects in Rural Iran” Virginia

Polytechnic Institute and State University .Department of Economics

National Statistics Office [Philippines] & ICF Macro (2009), “Philippines National

Demographic and Health Survey 2008: Key Findings, . Calverton, Maryland,

USA: NSO and ICF Macro.

Orbeta, Aniceto Jr. (2006), “Poverty, Fertility Preferences and Family Planning

Practice in the Philippines," Development Economics Working Papers 1781,

East Asian Bureau of Economic Research.

Thompson, M. E. (2001), “The Strategic Introduction of the Standard Days Method of

Family Planning in Armenia”, American University of Armenia Center for

Health Services Research, Retrieved November 2011

Townsend, John (2006), “Correlates of Inter-birth Intervals: Implications of Optimal

Birth Spacing Strategies in Mozambique”

Treiblmaier, H. & P. Filzmoser (2009), “Benefits from using continuous rating scales

in online survey research”, Institut f. Statistik U. Wahrscheinlichkeitstheorie,

Austria

D. Other References

De Guzman, F., Learning Module in Statistics, (Obtained 2008), The Philippine

Women’s University, p.118

Department of Health (DOH) (2006), The Philippine clinical standards manual on

family planning, Sta. Cruz, Manila, Philippines. DOH.

Family Planning Association of WA (2009), “Contraception”, FPWA Sexual Health

Services, Northbridge WA
 93

Fehring, R. & M. L. Barron (2005), “Basal Body Temperature Assessment: Is It

Useful to Couples Seeking Pregnancy?” Marquette University College of

Nursing Faculty Research and Publications, retrieved November 2011

Miguel-Aguirre, A. (2008), The Consolidated Reproductive Health Bill in the House

of Representatives, Medical Issues

Miller, G. (2005), “Contraception as Development? New evidence from family

planning in Colombia”, Retrieved November 2011, NBER working paper

w11704.

Nidoy, R. (2010), “Science Facts of RH Bill”, University of the Philippines Alumni

Association Publishing

Postlethwaire, D., et al. (2007), “Intrauterine contraception: evaluation of clinician

practice patterns in Kaiser Permanente Northern California. Contraceptions”,

75(3), 177-184.

Robinson, W. (2007), “The global family planning revolution: three decades of

population policies and programs”, World Bank Publications.

Smith, Ashford, et. al. (2009), Family planning saves lives. 4th Edition. Population

Reference Bureau; Washington, D.C.

Stockton, A. (2009), Birth Space, Safe Place: Emotional Well-Being through

Pregnancy and Birth .Findhorn Press.

E. Electronic Sources

AED (2011), Family Planning and STI Manual, AED, retrieved from

http://216.197.105.224/Libraries/Care Treatment/FamilyPlanningand

STI Manual.sflb.ashx
 94

Baringer, S. (2006), "The Philippines", In Countries and Their Cultures. Advameg

Inc., Retrieved 2012-3-16 from http://en.wikipedia.org/wiki/Philippines

Berg, M. (2011), “Problems Arising From Cohabitation”, E-how,

http://www.ehow.com/info_872319_problems-arising-cohabitation.html

Contra Costa Health Services (2001-2010), “Benefits of healthy birth spacing”. Public

health Division. Contra Costa County, California, USA. Retrieved August 20,

2011 from http://cchealth.org/topics/birth spacing/benefits.php

Family Health International (2009), “Natural methods of Family Planning FAQ”,

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Manila Bulletin (2011), “Population to Reach 97.6M”, Manila Bulletin Publishing

Corporation, Retrieved March 18, 2012 from

http://www.mb.com.ph/articles/346616/philippine-population-reach-976-m

Healthwise (2009), “Vaginal Problems - Home Treatment”, Healthwise, Incorporated,

retrieved from http://women.webmd.com/tc/vaginal problems-home-treatment

Kract, Linda (2010), “Responsible parenthood”, Retrieved August 15, 2011 from

http://www.fortifyingfamiliesoffaith.blogspot.com/2010/02/responsible parenth

ood.html.

de Miceli, A. (2009), No One Has to Die Tomorrow, Margaret Sanger, pro-"choice"

and Hitler's Eugenics.Civic News, en.wikipedia.org/wiki/Margaret_Sanger

National Statistic Coordination Board (2008), Family Planning Survey 2006, Retrieve

August 27, 2011 from http://www.nscb.gov.ph/ru9/document

/factsheet/2008/FS_2008_3_RD9_Q3.pdf
 95

Population Action International (2008), “Family planning in the Philippines: A global

wake-up call for policymakers” Washington, DC.

http://www.Populationaction.org

Religious Coalition for Reproductive Choice (2006), “Religious pro-choice Americans

speak out”, Washington, D.C. Retrieve August 25, 2011. http://rcrc.org

Sexually Transmitted Disease Resource (STDR) (2011), “Abstinence and Natural

Birth Control Methods”, Sexually Transmitted Disease Resource, retrieved

from http://www.sexual-health-

resource.org/natural birth control.htm#withdrawal

The Catholic Diocese of Raleigh (2011), “Natural Family planning”, Raleigh, North

Carolina, Retrieve August 25, 2011. http://www.dioceseofraleigh.org/how/nfp/

The State of the Philippine Population Report (2010), “Family planning: unmet needs

spawn direct consequences”, Retrieve August 24, 2011 from

http://www.popcom.goc.ph/sppr/sppr01.nfFamily Planning.htm

The Telegraph (2009), “Couples who live together before marriage more likely to get

divorced”, http://www.telegraph.co.uk/news/uknews/5840263/Couples-who-

live-together-before-marriage-more-likely-to-get-divorced.html

Thompson , M. et al. (2001), Feasibility Study: The Strategic Introduction of The

Standard Days Method of Family Planning In Armenia: Formative Research

Final Report, Yerevan: American University of Armenia, Center for Health

Services Research retrieved November 18, 2011 from

http://chsr.aua.am/PDF/2001/FeasibilityStudy/GeorgetownReportFINAL-

0228.PDF
 96

UNFPA (2007), “Family planning reduction benefits for families and nations”,

Retrieve August 26, 2011 from http://www.unfpa.org/rh/planning.htm

USAID (2008), Motivating Healthy Timing and Spacing of Pregnancies—Lessons

From The Field, Retrieve August 26, 2011 from

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pacing_Lessons_Learned.pdf

Villegas, B. (2011), “Little chance for RH Bill”, INQUIRER.net,

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Wills, Susan (2010), “Contraception: The fine print”, Retrieve August 15, 2011 from

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6, 2011 from

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 97

APPENDIX A

Letter of Request to Conduct Study

November 20, 2011

Ma.Victoria S. Cagnan, RN, MAN

President

Mother and Child Nurses Association of the Philippines (MCNAP)

Dear Madame:

Greetings of Peace!
The undersigned will be conducting a research on “Family Planning Methods Among Couples
of a Selected Barangay in Tacloban City: Basis For Healthcare Program Enhancement”, for
scholastic purposes in fulfillment of the requirements in Masters of Arts in Nursing at The
Philippine Women’s University, Manila.
In connection with this, may I request from your good office to conduct the said study in the
adopted Barangay of the organization pursuant to its goal in attaining its cause to Maternal
and Child Nursing improvement through continuous provision of safety quality care,
education and training, and research and management.
All gathered information thereunto shall be considered confidential and will not be used for
purposes other than what the study requires.
We hope for your favorable consideration. Thank you and more power.

Respectfully yours,

(Sgd.) Ric-An Artemio S. Gadin, BSN, RN

Researcher
The Philippine Women’s University

Noted by: Approved by:

(Sgd.) Prof. Ciriaco A. Ty, RN, RM, MD, MAN (Sgd.) Ma.Victoria S. Cagnan, RN, MAN
Research Adviser MCNAP President
The Philippine Women’s University
 98

June 5, 2012

Hon. Editha S. Monredondo

Barangay Chairman
Barangay 56 – A, Tacloban City

Dear Madame:

Greetings of Peace!

The undersigned will be conducting a research on “Family Planning Methods Among

Couples of a Selected Barangay in Tacloban City: Basis For Healthcare Program
Enhancement”, for scholastic purposes in fulfillment of the requirements in Masters
of Arts in Nursing at The Philippine Women’s University, Manila.

In connection with this, may I request from your good office pertinent Barangay
demographic profile and the permission to conduct the said study in your community.
All gathered information thereunto shall be considered confidential and will not be
used for purposes other than what the study requires.

We hope for your favorable consideration. Thank you and more power.

Respectfully yours,

(Sgd.) Ric-An Artemio Gadin, BSN, RN

Researcher
The Philippine Women’s University

Noted by:
Approved by:

(Sgd.) Prof. Ciriaco A. Ty, RN, RM, MD, MAN (Sgd.) Hon. Editha S. Monredondo
Research Adviser Barangay Chairman
The Philippine Women’s University Barangay 56 – A, Tacloban City
 99

APPENDIX B

Validation Letter

November 20, 2011

Ma. Victoria S. Cagnan, RN, MAN

President
Mother and Child Nurses Association of the Philippines (MCNAP)

Dear Madame:

Greetings of Peace and Joy!

I am Ric-An Artemio S. Gadin, RN, masteral student of the Philippine Women’s

University and is currently enrolled in Thesis Writing. In this regard, I would like to
seek your expertise to validate the questionnaire which is to be utilized in the study
entitled “Family Planning Methods Among Couples of a Selected Barangay in
Tacloban City: Basis For Healthcare Program Enhancement” for the fulfillment of the
Degree in Masters of Arts in Nursing in The Philippine Women’s University.

Attached herewith are the statement of the problem and the questionnaire for your
perusal.

Best regards and a heartfelt gratitude for your assistance.

Respectfully yours, Noted by:

(Sgd.) Ric-An Artemio Gadin, BSN, RN (Sgd.) Prof. Ciriaco A. Ty, RN, RM, MD, MAN
Researcher Research Adviser
The Philippine Women’s University The Philippine Women’s University
 100

APPENDIX C

INFORMED CONSENT

I, A Filipino, of legal age, hereby agree to participate in this research being

conducted Mr. Ric-An Artemio Gadin regarding the “Family Planning Methods

Among Couples of a Selected Barangay in Tacloban City: Basis For Healthcare

Program Enhancement”. I am willing to spend time for answering the questionnaire,

which will given, on the premise that all gathered information thereunto shall be

considered with utmost confidentiality and shall not be used for purposes other than

what the study requires.

As a proof of my agreement to the objectives and methodology of this study, I

hereby affix my signature below.

______________________________________ _________________________

Signature over Printed Name’ Date

 101

APPENDIX D

SURVEY QUESTIONNAIRE

Instructions: Please answer the following questions very briefly and as truthfully as

possible and do not leave unanswered items. All answers presented will be treated

with utmost confidentiality.

STATEMENT OF THE PROBLEM: The study tries to assess the level of awareness

practices of family planning methods among couples in a selected Barangay

in Tacloban City.

I. Demographic Profiles:

Name (Optional): _______________ Age: ______

Educational attainment:

□ None □ Elementary level □ Elementary graduate

□ High School level □ High School graduate □ College level

□ College graduate □ Post Graduate

Religion:

□ Christian □ Muslim □ Others ____________

Occupation:

□ None □ Government employee

□ Self-employed □ Private employee

Monthly Income: _Php____________________________________________

 102

No. of Children: _________________________________________________

No. of years using family planning: __________________________________

II. Level of Awareness

The questions in this section ask for your views and awareness regarding Family

Planning. You will be asked to select one response that matches most closely

with your perception of the statement.

Your responses are entirely confidential. No one in the will see the answers

you give, so please answer the questions as honestly as possible. There are no

“right” or “wrong” answers; it is your view that is important. The more honest you

are, the more valuable your response will be.

Instructions: Please answer how you regard your level of awareness regarding

Family Planning by answering the scale number from 0 to 10

9 - 10 - Aware to great extent

7-8 - Aware

5-6 - Moderately Aware

3-4 - Slightly Aware

0-2 - Not Aware

 103

A. How aware are you of the following concepts about the Family Planning

Program:

Family Planning Program Scale

1. There is a family planning program promoted by the
government?
2. There is a need for a family planning program?
3. Family planning may help to maintain a healthy mother and
child?
4. Family planning may save lives?
5. With small number of children, you will have more time and
money for everyone

B. How aware are you of the following Natural Method of family planning:

Abstinence Scale
1. The best way to prevent pregnancy is abstinence
2. This method promotes discipline and self concept
Coitus Interuptus / Withdrawal Scale
1. There will be no pregnancy when the penis is withdrawn and
ejaculation is done outside the vagina
2. This method requires time to learn
3. This might not be effective to male who cannot control their
ejaculation
Calendar / Rhythm / Standard Days Method Scale
1. Pregnancy may be prevented by not having coitus during
identified fertile days
2. The 8th – 19th day of every cycle are the days that females are
fertile
3. This method does not have side effects
Mucous / Billings / Ovulation Method Scale
1. There will be no pregnancy when coitus is done during
observed infertile days
2. This can be used by any women as long as there is no
unusual condition that result in extraordinary vaginal
discharges
3. There should be regular observation for presence of mucous
and observation of fertile days characteristics
 104

Lactating Amenorrhea Method Scale

1. That breastfeeding will help prevent pregnancy
2. There is a proper practice for this method to be effective
3. This method is effective up to six months after delivery

C. How aware are you of the following Artificial Method in family planning:
Birth Control Pills Scale
1. Pills can be utilized to prevent pregnancy?
2. Pills are more effective method but needs to be utilized
properly
3. Pills are taken every day
4. There are possible effects of pills on your body
Injectables Scale
1. There are Injections that can be utilized to prevent pregnancy?
2. This is a more effective method but should be done in the
appropriate time and frequency
3. Injection is administered every 3 months
4. There are possible effects of injectables on your body
Condom Scale
1. Condoms can be utilized to prevent pregnancy?
2. Male condom and female condoms are different
3. This is effective but needs to be utilized properly
4. There is a proper way of wearing condoms before every
intercourse
IUD Scale
1. IUDs can be utilized to prevent pregnancy?
2. This is very effective and is easier to use
3. Do you know how IUDs are used and inserted?

Bilateral Tubal Ligation Scale

1. Ligation may be a means of preventing pregnancy
2. This is very effective but is permanent
3. This method is a surgical procedure done in hospitals
4. There are possible complications this procedure may have
Vasectomy Scale
1. Male ligation may be a means of preventing pregnancy
2. This is very effective but is permanent
3. This method is a surgical procedure done in hospitals
4. There are possible complications this procedure may have
5. This is very effective and is easier to utilize
 105

III. Family Planning Practice

The questions in this section ask for the Family Planning Methods you practice.

You may answer more than one method.

Your responses are entirely confidential. No one in the will see the answers

you give, so please answer the questions as honestly as possible. There are no

“right” or “wrong” answers; it is your view that is important. The more honest you

are, the more valuable your response will be.

Instructions: Please answer which family planning methods you and your

partner practice. You may answer more than one.

A. Natural Method

Family Planning Method YES NO

1. Abstinence
2. Withdrawal
3. Lactation Amenorrhea Method
4. Standard Days Method
5. Mucous method
B. Artificial Method
Family Planning Method YES NO
1. Pills
2. Injections
3. Condom
Done Not Done
(1) (2)
4. IUD (Frequency of consultation) ______
5. Vasectomy
6. Bilateral Tubal Ligation
 106

APPENDIX E

Sample Analysis / Computations

Pearson’s Product Moment Correlation Computation

Machine Formula:

where: X – Age of Respondents

Y – scores obtained on extent of participatory decision

making and job satisfaction

n – sample size

Computer generated output:

Correlation between AGE and the following: Abstinence, Coitus, and

Calendar
 109

CURRICULUM VITAE

SANTAN ST BANEZVILLE II, FATIMA VILLAGE SAGKAHAN, TACLOBAN CITY, PHILIPPINES

BIRTH DATE: NOVEMBER 9, 19 • BIRTHPLACE: SEX: MALE

CITIZENSHIP: FILIPINO • RELIGION: CATHOLIC CHRISTIAN • CIVIL STATUS: SINGLE

CELLULAR PHONE • E – MAIL:

MOTHER: TERESITA

FATHER: ARTEMIO

RIC-AN ARTEMIO SURIO GADIN

LICENSURE and CERTIFICATION

Philippine Nurses Licensure Examination

PRC No : 0397151
Certified Nurse Intravenous Therapy Trainer
IV Card No : 07-3689
Certified Nurse in Internal Examination and Suturing of Perineal
Laceration
Card No : 09-0013

EDUCATION

2008 - Present Philippine Women’s University

Metro Manila
MASTERS OF ARTS IN NURSING
MAJOR IN NURSING ADMINISTRATION
(Complete Academic Requirements)
2002 – 2006 St. Scholastica’s College of Health Sciences
 110

Tacloban City, Leyte

BACHELOR OF SCIENCE IN NURSING
ASSOCIATE IN HEALTH SCIENCE EDUCATION
SERVICE RECORDS

CATARMAN DOCTORS HOSPITAL 2012 – Present

CHIEF NURSE
ST. SCHOLASTICA’S COLLEGE OF TACLOBAN 2010 – Present
FACULTY MEMBER (CLINICAL INSTRUCTOR)
OUR LADY OF PORZIUNCOLA HOSPITAL, INC. (OLPHI) 2009 – 2010
CLINICAL NURSE SUPERVISOR
OUR LADY OF PORZIUNCOLA HOSPITAL, INC. (OLPHI) 2007 – 2009
PERIOPERATIVE NURSE (ORT and PACUt)

ORGANIZATION MEMBERSHIPS

Philippine Red Cross Leyte Chapter, Tacloban City Chapter

Philippine Nurses Association, N. Leyte Chapter
Mother and Child Nursing Association of the Philippines
Operating Room Nurses Association of the Philippines
Association of Nursing Service Administrators of the Philippines
Catholic Nurses Guild of the Philippines